Regular exercise is associated with a reduction in the risk of NAFLD and decreased liver enzymes in individuals with NAFLD independent of obesity in Korean adults

Ji Cheol Bae, Sunghwan Suh, Se Eun Park, Eun Jung Rhee, Cheol Young Park, Ki Won Oh, Sung Woo Park, Sun Woo Kim, Kyu Yeon Hur, Jae Hyeon Kim, Myung-Shik Lee, Moon Kyu Lee, Kwang-Won Kim, Won-Young Lee, Ji Cheol Bae, Sunghwan Suh, Se Eun Park, Eun Jung Rhee, Cheol Young Park, Ki Won Oh, Sung Woo Park, Sun Woo Kim, Kyu Yeon Hur, Jae Hyeon Kim, Myung-Shik Lee, Moon Kyu Lee, Kwang-Won Kim, Won-Young Lee

Abstract

Background: We evaluated the association of regular physical exercise with the presence of non-alcoholic fatty liver disease (NAFLD) and liver enzymes in relation to obesity and insulin resistance.

Methodology/principal findings: A cross-sectional analysis was conducted in 72,359 healthy Korean adults without diabetes who participated in a comprehensive health check-up. Subjects who have been exercising regularly (more than 3 times per week, at least for 30 minutes each time and for consecutive 3 month) were categorized into exercise group. All subjects were categorized into deciles based on their body mass index (BMI) and we estimated the odds ratios (ORs) for having NAFLD according to exercise regularity in each decile. The diagnosis of NAFLD was based on ultrasonography findings. Individuals with NAFLD (n = 19,921) were analyzed separately to evaluate ORs for having elevated liver enzymes based on regularity of exercise. The risk for NAFLD was significantly reduced in exercise group with age- and sex-adjusted ORs of 0.53-0.72 for all BMI deciles except at BMI categories of <19.6 and 20.7-21.6 kg/m(2). While no difference was seen in BMI between subjects in exercise and non-exercise group across the BMI deciles, the values of body fat percentage and metabolic risk factors differed. Among NAFLD patients, subjects in exercise group had a lower risk for having elevated liver enzymes with multivariable adjusted OR of 0.85 (95% CI 0.74-0.99, for AST) and 0.74 (95% CI 0.67-0.81, for ALT) than did subjects in non-exercise group.

Conclusions/significance: Regular exercise was associated with a reduced risk for having NAFLD and decreased liver enzymes in patients with NAFLD, and this relationship was also independent of obesity.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. The risk for NAFLD by…
Figure 1. The risk for NAFLD by exercise regularity analyzed separately according to the BMI deciles.
A) Adjusted for age and sex. B) Adjusted for age, sex, and body fat percentage. Odds ratios were estimated from binary logistic regression analysis.
Figure 2. Association of metabolic risk factors…
Figure 2. Association of metabolic risk factors with exercise regularity across the BMI level. Adjusted for age and sex.

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