Sabag A, Way K L, Keating S E, Sultana R N, O'Connor H T, Baker M K, Chuter V H, George J, Johnson N A
Faculty of Health Sciences, University of Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia.
Faculty of Health Sciences, University of Sydney, NSW, Australia; Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Queensland, Australia.
Diabetes Metab. 2017 Jun;43(3):195-210. doi: 10.1016/j.diabet.2016.12.006. Epub 2017 Feb 2.
Ectopic adipose tissue surrounding the intra-abdominal organs (visceral fat) and located in the liver, heart, pancreas and muscle, is linked to cardio-metabolic complications commonly experienced in type 2 diabetes. A systematic review and meta-analysis was performed to determine the effect of exercise on ectopic fat in adults with type 2 diabetes. Relevant databases were searched to February 2016. Included were randomised controlled studies, which implemented≥4 weeks of aerobic and/or resistance exercise and quantified ectopic fat via magnetic resonance imaging, computed tomography, proton magnetic resonance spectroscopy or muscle biopsy before and after intervention. Risk of bias and study quality was assessed using Egger's funnel plot test and modified Downs and Black checklist, respectively. Of the 10,750 studies retrieved, 24 were included involving 1383 participants. No studies were found assessing the interaction between exercise and cardiac or pancreas fat. One study assessed the effect of exercise on intramyocellular triglyceride concentration. There was a significant pooled effect size for the meta-analysis comparing exercise vs. control on visceral adiposity (ES=-0.21, 95% CI: -0.37 to -0.05; P=0.010) and a near-significant pooled effect size for liver steatosis reduction with exercise (ES=-0.28, 95% CI: -0.57 to 0.01; P=0.054). Aerobic exercise (ES=-0.23, 95% CI: -0.44 to -0.03; P=0.025) but not resistance training exercise (ES=-0.13, 95% CI: -0.37 to 0.12; P=0.307) was effective for reducing visceral fat in overweight/obese adults with type 2 diabetes. These data suggest that exercise effectively reduces visceral and perhaps liver adipose tissue and that aerobic exercise should be a key feature of exercise programs aimed at reducing visceral fat in obesity-related type 2 diabetes. Further studies are required to assess the relative efficacy of exercise modality on liver fat reduction and the effect of exercise on pancreas, heart, and intramyocellular fat in type 2 diabetes and to clarify the effect of exercise on ectopic fat independent of weight loss.
围绕腹腔内器官的异位脂肪组织（内脏脂肪）以及存在于肝脏、心脏、胰腺和肌肉中的异位脂肪组织，与2型糖尿病中常见的心血管代谢并发症有关。进行了一项系统综述和荟萃分析，以确定运动对2型糖尿病成年人异位脂肪的影响。检索相关数据库至2016年2月。纳入的是随机对照研究，这些研究实施了≥4周的有氧运动和/或抗阻运动，并在干预前后通过磁共振成像、计算机断层扫描、质子磁共振波谱或肌肉活检对异位脂肪进行量化。分别使用Egger漏斗图检验和改良的唐斯和布莱克清单评估偏倚风险和研究质量。在检索到的10750项研究中，纳入了24项，涉及1383名参与者。未发现评估运动与心脏或胰腺脂肪之间相互作用的研究。一项研究评估了运动对肌内甘油三酯浓度的影响。在比较运动与对照对内脏脂肪的荟萃分析中，有显著的合并效应量（ES=-0.21，95%CI：-0.37至-0.05；P=0.010），运动减少肝脏脂肪变性有接近显著的合并效应量（ES=-0.28，95%CI：-0.57至0.01；P=0.054）。有氧运动（ES=-0.23，95%CI：-0.44至-0.03；P=0.025）对降低超重/肥胖2型糖尿病成年人的内脏脂肪有效，但抗阻训练运动（ES=-0.13，95%CI：-0.37至0.12；P=0.307）无效。这些数据表明，运动能有效减少内脏脂肪以及可能的肝脏脂肪组织，有氧运动应成为旨在减少肥胖相关2型糖尿病内脏脂肪的运动计划的关键组成部分。需要进一步研究来评估运动方式对减少肝脏脂肪的相对疗效以及运动对2型糖尿病患者胰腺、心脏和肌内脂肪的影响，并阐明运动对异位脂肪的影响是否独立于体重减轻。
