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

Sulin Cheng,Sulin Cheng,Ronald J H Borra,Ronald J H Borra,Ronald J H Borra,Ronald J H Borra,Dandan Ke,Yifan Yang,Jianqin Sun,Xiaobo Zhang,Xiaming Du,Na Wu,Riitta Parkkola,Riitta Parkkola,Petri Wiklund,Petri Wiklund,Petri Wiklund,Dajiang Lu,Can Zhao,Xiao Tan,Xiao Tan,Renwei Wang,Jun Ge,Yongyong Shi,Shenglong Le

doi:10.1038/s41598-017-16159-x

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.

Highlights

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the developing world, and occurs in 17–30% of the population in Western countries and 2–4% worldwide[1]
hepatic fat content (HFC) decreased to normal levels (
The current study shows, for the first time according to our knowledge that combined aerobic exercise and fibre-enriched diet reduces hepatic steatosis more than either exercise or increased fibre intake alone

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the developing world, and occurs in 17–30% of the population in Western countries and 2–4% worldwide[1]. Previous studies have shown that calorie restriction[5] and exercise are effective ways to improve hepatic steatosis[6] and insulin sensitivity[7], and are recommended as a first-line interventions for prevention and treatment of NAFLD and pre-diabetes[8]. To date, no randomized control study has evaluated the effect of combined aerobic exercise and fibre-enriched diet on reduction of HFC and glycaemic control in people with both pre-diabetes and NAFLD. Exercise or dietary intervention alone showed effective benefit on glycaemic control and NAFLD reduction, no study so far has assessed the combined effect of both exercise and high fibre intake on glycaemic control and hepatic steatosis in people with pre-diabetes and NAFLD. We aimed to test our hypothesis that exercise training combined with increased fibre intake reduces hepatic steatosis and improves glycaemic control in pre-diabetic patients with NAFLD. The study has been registered in the International Standard Randomized Controlled Trial Number Register (ISRCTN 42622771, Date applied 10/04/2013, Date assigned, 23/04/2013, Last edited 02/02/2017)

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