Department of Vascular Medicine, Amsterdam Gastroenterology, Endocrinology Metabolism, Amsterdam UMC, Location AMC at University of Amsterdam, Amsterdam, Netherlands.
Department of Experimental Vascular Medicine, Amsterdam Gastroenterology, Endocrinology Metabolism, Amsterdam UMC, Location AMC at University of Amsterdam, Amsterdam, Netherlands.
Front Endocrinol (Lausanne). 2022 Nov 3;13:1032164. doi: 10.3389/fendo.2022.1032164. eCollection 2022.
Exercise is an effective strategy for the prevention and regression of hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD), but it is unclear whether it can reduce advanced stages of NAFLD, i.e., steatohepatitis and liver fibrosis. Furthermore, it is not evident which modality of exercise is optimal to improve/attenuate NAFLD.
The aim is to systematically review evidence for the effect of aerobic exercise (AE) on NAFLD, in particular non-alcoholic steatohepatitis (NASH) and liver fibrosis.
A systematic literature search was conducted in Medline and Embase. Studies were screened and included according to predefined criteria, data were extracted, and the quality was assessed by Cochrane risk of bias tools by two researchers independently according to the protocol registered in the PROSPERO database (CRD42021270059). Meta-analyses were performed using a bivariate random-effects model when there were at least three randomized intervention studies (RCTs) with similar intervention modalities and outcome.
The systematic review process resulted in an inclusion a total of 24 studies, 18 RCTs and six non-RCTs, encompassing 1014 patients with NAFLD diagnosed by histological or radiological findings. Studies were grouped based on the type of AE: moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT). A total of twelve meta-analyses were conducted. Compared to controls, MICT resulted in a mean difference (MD) in the NAFLD biomarkers alanine transaminase (ALT) and aspartate aminotransferase (AST) of -3.59 (CI: -5.60, -1.59, p<0.001) and -4.05 (CI: -6.39, -1.71, p<0.001), respectively. HIIT resulted in a MD of -4.31 (95% CI: -9.03, 0.41, p=0.07) and 1.02 (95% CI: -6.91, 8.94, p=0.8) for ALT and AST, respectively. Moreover, both AE types compared to controls showed a significantly lower magnetic resonance spectroscopy (MRS) determined liver fat with a MD of -5.19 (95% CI: -7.33, -3.04, p<0.001) and -3.41 (95% CI: -4.74, -2.08, p<0.001), for MICT and HIIT respectively. MICT compared to controls resulted in a significantly higher cardiorespiratory fitness (MD: 4.43, 95% CI: 0.31, 8.55, p=0.03).
Liver fat is decreased by AE with a concomitant decrease of liver enzymes. AE improved cardiorespiratory fitness. Further studies are needed to elucidate the impact of different types of AE on hepatic inflammation and fibrosis.
https://www.crd.york.ac.uk/prospero/, identifier (CRD42021270059).
运动是预防和逆转非酒精性脂肪性肝病（NAFLD）患者肝脂肪变性的有效策略，但尚不清楚运动是否可以减少 NAFLD 的晚期阶段，即脂肪性肝炎和肝纤维化。此外，哪种运动方式最适合改善/减轻 NAFLD 尚不清楚。
旨在系统回顾有氧运动（AE）对 NAFLD，特别是非酒精性脂肪性肝炎（NASH）和肝纤维化影响的证据。
在 Medline 和 Embase 中进行了系统文献检索。根据预设标准筛选和纳入研究，提取数据，并由两名研究人员根据在 PROSPERO 数据库（CRD42021270059）中注册的方案使用 Cochrane 偏倚风险工具独立评估质量。当至少有三项具有相似干预方式和结局的随机干预研究（RCT）时，使用双变量随机效应模型进行荟萃分析。
系统审查过程共纳入了 24 项研究，18 项 RCT 和 6 项非 RCT，共纳入了 1014 名经组织学或影像学诊断为 NAFLD 的患者。研究根据 AE 类型进行分组：中等强度持续训练（MICT）和高强度间歇训练（HIIT）。共进行了 12 项荟萃分析。与对照组相比，MICT 使 NAFLD 生物标志物丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）的平均差值分别为 -3.59（CI：-5.60，-1.59，p<0.001）和 -4.05（CI：-6.39，-1.71，p<0.001）。HIIT 使 ALT 和 AST 的平均差值分别为 -4.31（95% CI：-9.03，0.41，p=0.07）和 1.02（95% CI：-6.91，8.94，p=0.8）。此外，与对照组相比，两种 AE 类型均显示出肝脏脂肪的磁共振光谱（MRS）确定的显著降低，MICT 和 HIIT 的平均差值分别为 -5.19（95% CI：-7.33，-3.04，p<0.001）和 -3.41（95% CI：-4.74，-2.08，p<0.001）。与对照组相比，MICT 使心肺功能适应性显著提高（MD：4.43，95% CI：0.31，8.55，p=0.03）。
运动可降低肝脏脂肪含量，同时降低肝脏酶水平。AE 可提高心肺功能适应性。需要进一步研究不同类型的 AE 对肝脏炎症和纤维化的影响。
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