Kistler Kristin D, Brunt Elizabeth M, Clark Jeanne M, Diehl Anna Mae, Sallis James F, Schwimmer Jeffrey B
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, California 92103, USA.
Am J Gastroenterol. 2011 Mar;106(3):460-8; quiz 469. doi: 10.1038/ajg.2010.488. Epub 2011 Jan 4.
Factors that determine disease severity in nonalcoholic fatty liver disease (NAFLD) are unclear, but exercise is a recommended treatment. We evaluated the association between physical activity intensity and histological severity of NAFLD.
We conducted a retrospective analysis of adults with biopsy-proven NAFLD enrolled in the NASH CRN (Nonalcoholic Steatohepatitis Clinical Research Network). Using self-reported time spent in physical activity, we classified participants as inactive or as meeting the US guidelines for either moderate or vigorous exercise. Histology was reviewed by a central pathology committee. Frequency and odds of steatohepatitis (NASH) and advanced fibrosis were compared between subjects who either met or did not meet exercise recommendations, and by the total amount of exercise per week.
A total of 813 adults (males=302, females=511) with NAFLD were included, with a mean age of 48 years. Neither moderate-intensity exercise nor total exercise per week was associated with NASH or stage of fibrosis. Meeting vigorous recommendations was associated with a decreased adjusted odds of having NASH (odds ratio (OR): 0.65 (0.43-0.98)). Doubling the recommended time spent in vigorous exercise, as is suggested for achieving additional health benefits, was associated with a decreased adjusted odds of advanced fibrosis (OR: 0.53 (0.29-0.97)).
These data support an association of vigorous but not moderate or total exercise with the severity of NAFLD. Optimal doses of exercise by duration and intensity for the prevention or treatment of NASH have not been established; however, intensity may be more important than duration or total volume.
非酒精性脂肪性肝病（NAFLD）中决定疾病严重程度的因素尚不清楚，但运动是推荐的治疗方法。我们评估了体力活动强度与NAFLD组织学严重程度之间的关联。
我们对纳入非酒精性脂肪性肝炎临床研究网络（NASH CRN）且经活检证实患有NAFLD的成年人进行了回顾性分析。根据自我报告的体力活动时间，我们将参与者分为不活动或符合美国中度或剧烈运动指南的人群。组织学由中央病理委员会进行审查。比较了符合或不符合运动建议的受试者之间以及按每周运动总量划分的脂肪性肝炎（NASH）和晚期纤维化的频率及比值比。
共纳入813名患有NAFLD的成年人（男性=302名，女性=511名），平均年龄48岁。中度强度运动和每周总运动量均与NASH或纤维化阶段无关。符合剧烈运动建议与NASH调整后比值比降低相关（比值比（OR）：0.65（0.43 - 0.98））。为获得更多健康益处而将建议的剧烈运动时间加倍，与晚期纤维化调整后比值比降低相关（OR：0.53（0.29 - 0.97））。
这些数据支持剧烈运动而非中度运动或总运动量与NAFLD严重程度之间存在关联。尚未确定预防或治疗NASH的运动持续时间和强度的最佳剂量；然而，强度可能比持续时间或总量更重要。
