Effect of aerobic exercise and diet on liver fat in pre-diabetic patients with non-alcoholic-fatty-liver-disease: A randomized controlled trial

Abstract

The study aimed to assess whether aerobic exercise (AEx) training and a fibre-enriched diet can reduce hepatic fat content (HFC) and increase glycaemic control in pre-diabetic patients with non-alcoholic fatty liver disease (NAFLD). Six-hundred-and-three patients from seven clinics in Yangpu district, Shanghai, China were recruited. Of them 115 individuals aged 50–65-year fulfilled the inclusion criteria (NAFLD with impaired fasting glucose or impaired glucose tolerance) and were randomly assigned into exercise (AEx n = 29), diet (Diet n = 28), exercise plus diet (AED n = 29), or no-intervention (NI n = 29) groups. Progressive supervised AEx training (60–75% VO2max intensity) was given 2-3 times/week in 30–60 min/sessions, and the diet intervention was provided as lunch with 38% carbohydrate and diet fibre of 12 g/day for 8.6-month. HFC was assessed by 1H MRS. We found that HFC was significantly reduced in the AEx (−24.4%), diet (−23.2%), and AED (−47.9%) groups by contrast to the 20.9% increase in the NI group (p = 0.001 for all) after intervention. However, only AED group significantly decreased HbA1c (−4.4%, p = 0.01) compared with the NI group (−0.6%). Aerobic exercise training combined with fibre-enriched diet can reduce HFC more effectively than either exercise or increased fibre-intake alone in pre-diabetic patients with NAFLD.

Sex-based differences in hepatic and skeletal muscle triglyceride storage and metabolism

“…Both endurance and resistance training are effective strategies to lower IHTG content in individuals with NAFLD independent of diet and/or weight loss (Hallsworth et al 2011;Keating et al 2012;Cheng et al 2017;Katsagoni et al 2017), with no differences in effectiveness between the two modes (Bacchi et al 2013; Katsagoni et al 2017). Importantly, the effect of training on IHTG content in individuals with NAFLD is similar to that of an energy-restricted, low carbohydrate diet (exercise: -24.4%, diet: -23.3%), with greater effects seen when both are D r a f t combined [-47.9%, (Liu et al 2014)].…”

Nutritional Strategies in Prediabetes: A Scoping Review of Recent Evidence

“…Eleven of the reported interventions were not exclusively nutritional, but rather a combination of diet and exercise [ 22 , 26 , 27 , 29 , 30 , 34 , 38 , 40 , 75 , 84 , 88 ]. Overall, diet–exercise interventions demonstrated better results than each of these alone [ 29 , 75 ].…”

“…Eleven of the reported interventions were not exclusively nutritional, but rather a combination of diet and exercise [ 22 , 26 , 27 , 29 , 30 , 34 , 38 , 40 , 75 , 84 , 88 ]. Overall, diet–exercise interventions demonstrated better results than each of these alone [ 29 , 75 ]. Notably, five studies with a total of 1872 participants examined the effects of increased physical activity with a diet of ~50% carbohydrates, <35% fat and increased fiber [ 22 , 26 , 38 , 40 , 88 ].…”

“…A well-balanced diet with plenty of fruit and vegetables, compounded with ample exercise, was supported by large studies as effective strategies for slowing diabetes progression and complications [ 29 , 30 , 34 ], as was reducing alcohol intake [ 27 , 30 ]. Likewise, caloric and fat restrictions with regular physical activity successfully lowered HbA1c levels, insulin resistance and the risk of advancing to drug-treated diabetes [ 27 , 75 , 84 ].…”

“…Eight studies (57.1%) recorded statistically significant improvements [ 22 , 26 , 27 , 33 , 34 , 36 , 53 , 93 ]. An assessment of performance in physical activity or aerobic fitness, often measured by maximal peak oxygen consumption (VO 2 max), across 10 studies showed improvement in seven of them (70%) [ 27 , 29 , 40 , 71 , 74 , 98 , 111 ].…”