Backgrounds: Dimethylguanidino valeric acid (DMGV) is closely associated with nonalcoholic fatty liver disease (NAFLD), the most recommended therapy of NAFLD is Exercise. Our aim was to investigate the correlation between DMGV concentrations and clinical characters in patients with NAFLD, and assessed the effect on DMGV concentrations changes after 6 month exercise training.Methods: NAFLD individuals (n = 220) were selected and randomly divided into control group (n = 74), moderate exercise group (n = 73) and vigorous exercise group (n = 73) with 6 month followed-up. Clinical characteristics were obtained from our previous clinical trial, serum DMGV levels were determined by a validated ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method.Results: On baseline, DMGV levels were positive associated with age, visceral fat and intrahepatic triglyceride (IHTG) content, and inversely associated with fasting blood glucose and diastolic blood pressure. In addition, the association between DMGV levels and IHTG content remained significant after adjusting other main clinical characters (β coefficient = 0.174, P = 0.018). After 6 month exercise training, IHTG was decreased by both exercise intensities without a significant difference (P = 0.45), however, moderate exercise was more efficient on DMGV decreasing than vigorous exercise (-9.96 to 2.27 ng/ml, P < 0.001 for moderate exercise; -4.53 to 4.56 ng/ml, P = 0.762 for vigorous exercise) with a significant difference (P = 0.047).Conclusions: DMGV was a potential indicator during development and progression of NAFLD, and moderate exercise was more efficient on metabolic changes than vigorous exercise with equal IHTG improvement, suggesting a priority of exercise intensity during NAFLD treatment.ClinicalTrials.gov Identifier: NCT01418027, August 16, 2011