Physical Activity and Nonalcoholic Fatty Liver Disease LIVER NEWS ELSEWHERE

Ylse Gutierrez-Grobe, Juan Gavilanes-Espinar, Nahum Méndez-Sánchez, Nahum Méndez-Sánchez, George St, Bauman, Johnston, Farrell, Chey, George
2009 Physical Activity and Nonalcoholic Fatty Liver Disease   unpublished
Independent effects of physical activity in patients with nonalcoholic fatty liver disease. Hepatology. 2009; 50:68-76. Nonalcoholic fatty liver disease, characterized by elevated liver enzymes, central obesity, and insulin resistance, is becoming increasingly prevalent. The effects of changes in physical activity on the metabolic profile of this group have not been reported. We assessed at 3 months the impact of a behavior change based lifestyle intervention on physical activity and the
more » ... vity and the effects of this change on the metabolic profile of people with fatty liver disease. In all, 141 participants with nonalcoholic fatty liver disease were prospectively enrolled into either a low-or moderate intensity lifestyle intervention or to a control group. Physical activity was assessed using a validated reporting tool and physical fitness was measured using the YMCA protocol on a cycle ergometer. Individualized counseling to increase physical activity was provided. Overall, 96% of participants attended the 3-month follow-up assessment. Participants in the moderate-and low-intensity intervention groups were 9 times more likely to increase physical activity by an hour or more per week compared to controls. Patients increasing or maintaining their reported physical activity to > 150 minutes/week, and those who increased their objective levels of fitness, had the greatest improvements in liver enzymes and other metabolic indices compared to those who were least active. This effect was independent of weight loss and was corroborated by an objective measure of fitness. There was no dose-response effect on liver enzymes with incremental increases in physical activity above 60 minutes/ week. Conclusion: Lifestyle counseling interventions are effective in improving physical activity behavior. Maintaining or increasing physical activity provides health benefits for patients with fatty liver, independent of changes in weight. Abstract published under permission of Wiley-Blackwell In the present study, St George et al. 1 found that both moderate and low-intensity lifestyle interventions resulted in changes in physical activity (PA) behavior in patients with nonalcoholic fatty liver disease (NAFLD). These changes in turn resulted in significantly improve of some metabolic parameters. In fact, this group of researches observed that patients who increased PA by an hour or more a week had the greatest improvements in metabolic and obesity related variables, whereas those who remained or became sedentary had no improvement, and a clear trend toward deterioration in several metabolic parameters. Interestingly, improvement in liver enzymes was similar in both groups, those who increased PA and those who maintained the recommended amount for health benefits, despite the latter group's not achieving improvement in other metabolic indicators. NAFLD is a pathologic condition that is closely related to insulin resistance, as well as other cardio-vascular risk factors, such as obesity, diabetes melli-tus and hyperlipidaemia. 2 NAFLD includes a broad spectrum of clinic presentation ranging from simple steatosis to steatohepatitis and liver cihrrosis. 3 The current first-line management in these patients is a prescription of diet, exercise and weight loss. 2,4,5 Regarding the effect of exercise in NAFLD, Zelber et al. 6 , in one population-based study carried out in a subgroup of the Israeli National Health and Nu