Impact of Physical Activity Differences Due to COVID-19 Pandemic Lockdown on Non-Alcoholic Fatty Liver Parameters in Adults with Metabolic Syndrome

Abstract

Background: A Mediterranean lifestyle with a Mediterranean diet and regular physical activity (PA) improves metabolic syndrome (MetS) characteristics and non-alcoholic fatty liver disease (NAFLD). The COVID-19 pandemic stopped healthy habits and increased NAFLD progression. Objectives: To assess how PA differences due to COVID-19 lockdown affected NAFLD parameters in adults with MetS. Design: Longitudinal 2-year analysis of data obtained between COVID-19 pre- and post-lockdown in a parallel-group randomized trial (n = 57, aged 40–60 years old, with MetS and NAFLD). Methods: NAFLD status and related parameters were assessed by magnetic resonance imaging (MRI), blood collection analysis and related indexes. PA and fitness status were assessed by an Alpha-Fit test battery, accelerometers, validated Minnesota questionnaire and functional fitness score. During lockdown, study personnel telephoned patients to motivate them. Participants were grouped according to PA levels. Results: The low PA group improved its fitness score tests (0.2) after lockdown more than the medium PA group, and it decreased its sedentary activity (−48.7 min/day), increased light (20.9 min/day) and moderate (32.3 min/day) PA intensities and improved sleep efficiency (0.6%) in comparison with the medium and high PA groups. The high PA group increased its steps per day more than the other groups. The low PA group was the only group that decreased its gamma glutamyl transferase (GGT) levels (−17.0 U/L). All groups increased their fatty liver index (FLI) after lockdown, but the medium PA group increased its FLI more than the low PA group. Participants in the high PA group decreased their HDL-cholesterol levels more than participants in the medium PA group (−0.4 mg/dL). Conclusions: Stopping regular PA together with an unhealthy lifestyle leads to a worsening of MetS and NAFLD. COVID-19 lockdown induced a decrease in PA in more active people, but inactive people increased their PA levels. Motivation seemed to be very important during lockdown.

Associations between Liver Enzymes, Lifestyle Risk Factors and Pre-Existing Medical Conditions in a Population-Based Cross-Sectional Sample

“…Regular physical exercise is known to lead to more favorable metabolic profiles and reduction in the levels of the biomarkers of inflammation and liver status [ 50 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ]. Physical activity may also play a role in regulating the status of inflammation and oxidative stress [ 35 , 50 , 96 , 97 ]. In obese individuals, liver enzyme activities have been shown to correlate with the degree of fat deposition and to decline with losing weight.…”

Impact of Physical Activity on the Characteristics and Metabolic Consequences of Alcohol Consumption: A Cross-Sectional Population-Based Study

“…Taking physical exercise in a regular manner as part of treatment protocols may be expected to lead to more favorable metabolic profiles with associated reduction in the levels of predictive biomarkers of health [ 18 , 24 , 57 , 58 ]. Physical activity seems to play a role in correct maintenance of GGT enzyme, which based on previous observations can be considered a marker of oxidative stress and a mechanistic link between hepatic and extrahepatic disease manifestations due to its pathogenic role in LDL oxidation in coronary arteries [ 57 , 59 , 60 ].…”

Non-alcoholic fatty liver disease and COVID-19: Harmless companions or disease intensifier?

“…The average fatty liver index (FLI) as a surrogate for NAFLD increased from 25.2 to 33 in this study[ 73 ]. Another Spanish study showed a decrease in physical activity during lockdown with a consecutive increase in FLI and worsening of metabolic status[ 74 ]. In an Italian cohort study, 48% of 357 NAFLD patients gained weight during lockdown, and this weight gain was associated with abandonment of a Mediterranean diet and decreased physical activity in univariate analysis and various multivariate models.…”