Exercise and non-alcoholic fatty liver disease: A systematic review and meta-analysis

Keating, Shelley E.; Hackett, Daniel; George, Jacob; Johnson, Nathan A.

doi:10.1016/j.jhep.2012.02.023

Cited by 435 publications

(369 citation statements)

References 47 publications

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“…Physical activity follows a dose-effect relationship and vigorous (running) rather than moderate exercise (brisk walking) carries the full benefit, including for NASH and fibrosis [110,117,118] Any engagement in physical activity or increase over previous levels is however better than continuing inactivity.…”

Section: Fructose Intakementioning

confidence: 99%

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

2016

Journal of Hepatology

3,586

1,817

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DefinitionNAFLD is characterised by excessive hepatic fat accumulation, associated with insulin resistance (IR), and defined by the presence of steatosis in >5% of hepatocytes according to histological analysis or by the proton density fat fraction (PDFF, providing a rough estimation of the volume fraction of fatty material in the liver) >5.6% assessed by proton magnetic resonance spectroscopy ( 1 H-MRS) or quantitative fat/water selective magnetic resonance imaging (MRI). NAFLD includes two pathologically distinct conditions with different prognoses: nonalcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH); the latter covers a wide spectrum of disease severity, including fibrosis, cirrhosis and hepatocellular carcinoma (HCC) ( table 2 ).The diagnosis of NAFLD requires exclusion of both secondary causes and a daily alcohol consumption ≥ 30 g for men and 20 g for women [1] . The relationship between alcohol and liver injury depends on several cofactors (type of alcoholic beverage, drinking patterns, duration of exposure, individual/genetic susceptibility), rendering simple quantitative thresholds at least partly arbitrary. Specifically, patients consuming moderate amounts of alcohol may be still predisposed to NAFLD if they have metabolic risk factors. Of note, the overall impact of metabolic risk factors on the occurrence of steatosis appears to be higher than that of alcohol in these patients [3] . The definitive diagnosis of NASH requires a liver biopsy. Recommendations• Patients with IR and/or metabolic risk factors (i.e., obesity or metabolic syndrome (MetS)) should undergo diagnostic procedures for the diagnosis of NAFLD, which relies on the demonstration of excessive liver fat (A1) • Individuals with steatosis should be screened for secondary causes of NAFLD, including a careful assessment of alcohol intake. The interaction between moderate amounts of alcohol and metabolic factors in fatty liver should always be considered (A1) • Other chronic liver diseases, that may coexist with NAFLD, should be identified as this might result in more severe liver injury (B1) Prevalence and IncidenceNAFLD is the most common liver disorder in Western countries, affecting 17-46% of adults, with differences according to the diagnostic method, age, sex and ethnicity [4] . It parallels the prevalence of MetS and its components, which also increases the risk of more advanced disease, both in adults and in children. NAFLD is also present in 7% of normalweight (lean) persons [5] , more frequently in females, at a younger age and with normal liver enzymes. Their liver disease may nonetheless be progressive [6] .NAFLD incidence has rarely been measured. It was 20-86/1,000 person-years based on elevated liver enzymes and/or on ultrasound (US), and 34/1,000 per year by 1 H-MRS [7] . The need for NAFLD screening in the community has been questioned given the high direct and indirect costs of testing, the low predictive value of non-invasive tests, the risks of liver biopsy and the lack of effective treatments [8] . Ho...

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Section: Fructose Intakementioning

confidence: 99%

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

2016

Journal of Hepatology

3,586

1,817

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“…• 150-200 min/week of moderate-intensity aerobic physical activities in 3-5 sessions are generally preferred (brisk walking, stationary cycling) • Resistance training is also effective and promotes musculoskeletal fitness, with effects on metabolic risk factors • High rates of inactivity-promoting fatigue and daytime sleepiness reduce compliance with exercise Physical activity follows a dose-effect relationship and vigorous (running) rather than moderate exercise (brisk walking) carries the full benefit, including for NASH and fibrosis [110,117,118] Any engagement in physical activity or increase over previous levels is however better than continuing inactivity.…”

Section: Macronutrient Compositionmentioning

confidence: 99%

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

2016

Diabetologia

552

248

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“…It is generally accepted that regular exercise leads to non-significant or small amounts of weight loss, but there are multiple benefits nonetheless. Human data clearly demonstrate that regular exercise itself reduces liver fat and can do so in the absence of clinically significant weight loss [4][5][6][7]. These data are supported by cross-sectional analyses which collectively demonstrate an inverse relationship between physical activity, physical fitness and NAFLD [8].…”

mentioning

confidence: 70%

The benefits of exercise for patients with non-alcoholic fatty liver disease

Keating

George

Johnson

2015

Expert Review of Gastroenterology & Hepatology

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Exercise and non-alcoholic fatty liver disease: A systematic review and meta-analysis

Cited by 435 publications

References 47 publications

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

The benefits of exercise for patients with non-alcoholic fatty liver disease

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