Division of Gastroenterology and Hepatology, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA.
Nutrients. 2023 Mar 20;15(6):1481. doi: 10.3390/nu15061481.
Exercise remains a key component of nonalcoholic fatty liver disease (NAFLD) treatment. However, mechanisms underpinning the improvements in NAFLD seen with exercise are unclear. Exercise improved liver fat and serum biomarkers of liver fibrosis in the NASHFit trial. We investigated exercise's mechanism of benefit by conducting a post hoc analysis of these data to determine the relationship between serum fibroblast growth factor (FGF) 21, which is implicated in NAFLD development, and exercise.
In the 20 wk NASHFit trial, patients with nonalcoholic steatohepatitis (NASH) were randomized to receive moderate-intensity aerobic exercise training or standard clinical care. Mediterranean-informed dietary counseling was provided to each group. Change in serum FGF21 was measured after an overnight fast.
There was a significant improvement in serum FGF21 with exercise training compared to standard clinical care ( = 0.037) with serum FGF21 reducing by 22% (-243.4 +/-349 ng/mL) with exercise vs. a 34% increase (+88.4 ng/mL +/-350.3 ng/mL) with standard clinical care. There was a large inverse association between change in serum FGF21 and change in cardiorespiratory fitness (VOpeak) (r = -0.62, 95% CI -0.88 to -0.05, = 0.031), and on multivariable analysis, change in VOpeak remained independently associated with change in FGF21 (β = -44.5, 95% CI -83.8 to -5.11, = 0.031).
Serum FGF21 is markedly decreased in response to aerobic exercise training, offering a novel mechanism to explain the observed reduction in liver fat and improvement in serum biomarkers of liver fibrosis in patients with NASH who do exercise.
运动仍然是非酒精性脂肪性肝病（NAFLD）治疗的关键组成部分。然而，运动改善 NAFLD 的机制尚不清楚。在 NASHFit 试验中，运动改善了肝脂肪和血清肝纤维化生物标志物。我们通过对这些数据进行事后分析来研究运动的获益机制，以确定与 NAFLD 发展有关的血清成纤维细胞生长因子（FGF）21 与运动之间的关系。
在 20 周的 NASHFit 试验中，非酒精性脂肪性肝炎（NASH）患者被随机分配接受中等强度的有氧运动训练或标准临床护理。两组均接受地中海饮食咨询。空腹一夜后测量血清 FGF21 的变化。
与标准临床护理相比，运动训练可显著改善血清 FGF21（ = 0.037），运动组血清 FGF21 降低 22%（-243.4 ± 349 ng/mL），而标准临床护理组增加 34%（+88.4 ng/mL ± 350.3 ng/mL）。血清 FGF21 的变化与心肺功能适应性（VOpeak）的变化呈显著负相关（r = -0.62，95%CI -0.88 至 -0.05， = 0.031），多变量分析显示，VOpeak 的变化与 FGF21 的变化独立相关（β = -44.5，95%CI -83.8 至 -5.11， = 0.031）。
有氧运动训练可显著降低血清 FGF21，为解释运动改善 NASH 患者肝脂肪和血清肝纤维化生物标志物提供了新的机制。
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