Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Department of Public Health Sciences, The Pennsylvania State University-College of Medicine, Hershey, Pennsylvania, USA.
Am J Gastroenterol. 2023 Jul 1;118(7):1204-1213. doi: 10.14309/ajg.0000000000002098. Epub 2022 Dec 23.
Exercise training is crucial in the management of nonalcoholic fatty liver disease (NAFLD); however, whether it can achieve clinically meaningful improvement in liver fat is unclear. We investigated the association between exercise training and the achievement of validated thresholds of MRI-measured treatment response.
Randomized controlled trials in adults with NAFLD were identified through March 2022. Exercise training was compared with no exercise training. The primary outcome was ≥30% relative reduction in MRI-measured liver fat (threshold required for histologic improvement in nonalcoholic steatohepatitis activity, nonalcoholic steatohepatitis resolution, and liver fibrosis stage). Different exercise doses were compared.
Fourteen studies (551 subjects) met inclusion criteria (mean age 53.3 yrs; body mass index 31.1 kg/m 2 ). Exercise training subjects were more likely to achieve ≥30% relative reduction in MRI-measured liver fat (odds ratio 3.51, 95% confidence interval 1.49-8.23, P = 0.004) than those in the control condition. An exercise dose of ≥750 metabolic equivalents of task min/wk (e.g., 150 min/wk of brisk walking) resulted in significant treatment response (MRI response odds ratio 3.73, 95% confidence interval 1.34-10.41, P = 0.010), but lesser doses of exercise did not. Treatment response was independent of clinically significant body weight loss (>5%).
Independent of weight loss, exercise training is 3 and a half times more likely to achieve clinically meaningful treatment response in MRI-measured liver fat compared with standard clinical care. An exercise dose of at least 750 metabolic equivalents of task-min/wk seems required to achieve treatment response. These results further support the weight-neutral benefit of exercise in all patients with NAFLD.
运动训练对于非酒精性脂肪性肝病（NAFLD）的治疗至关重要；然而，其是否能使肝脂肪量得到有临床意义的改善尚不清楚。我们研究了运动训练与通过 MRI 测量的治疗应答验证阈值的达成之间的相关性。
通过 2022 年 3 月，我们确定了非酒精性脂肪性肝病成人患者的随机对照试验。将运动训练与不运动训练进行比较。主要结局是 MRI 测量的肝脂肪量相对减少≥30%（非酒精性脂肪性肝炎活动度、非酒精性脂肪性肝炎缓解和肝纤维化分期的组织学改善所需的阈值）。比较了不同的运动剂量。
符合纳入标准的 14 项研究（551 例患者）（平均年龄 53.3 岁；体重指数 31.1 kg/m 2 ）。与对照组相比，运动训练组更有可能实现 MRI 测量的肝脂肪量相对减少≥30%（优势比 3.51，95%置信区间 1.49-8.23，P = 0.004）。运动剂量≥750 代谢当量任务分钟/周（例如，快步走 150 分钟/周）可导致显著的治疗应答（MRI 应答优势比 3.73，95%置信区间 1.34-10.41，P = 0.010），但较小的运动剂量则不行。治疗应答与临床显著的体重减轻（>5%）无关。
与体重减轻无关，与标准临床护理相比，运动训练使 MRI 测量的肝脂肪量达到有临床意义的治疗应答的可能性高出 3.5 倍。至少 750 代谢当量任务-min/wk 的运动剂量似乎是达到治疗应答所需的。这些结果进一步支持了运动在所有非酒精性脂肪性肝病患者中的体重中性益处。
