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Cited by 194Liver Disease Diagnosis and TreatmentDiabetes, Cardiovascular Risks, and LipoproteinsDiet, Metabolism, and Disease

Diet and Exercise Interventions Reduce Intrahepatic Fat Content and Improve Insulin Sensitivity in Obese Older Adults

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Shah, Krupa, Stufflebam, Abby, Hilton, Tiffany N., Sinacore, David R., Klein, Samuel, Villareal, Dennis T.·2009·Obesity
DOI 10.1038/oby.2009.126PMC PMC2793412
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Abstract

Both obesity and aging increase intrahepatic fat (IHF) content, which leads to nonalcoholic fatty liver disease (NAFLD) and metabolic abnormalities such as insulin resistance. We evaluated the effects of diet and diet in conjunction with exercise on IHF content and associated metabolic abnormalities in obese older adults. Eighteen obese (BMI ≥30 kg/m 2) older (≥65 years old) adults completed a 6‐month clinical trial. Participants were randomized to diet (D group; n = 9) or diet + exercise (D+E group; n = 9). Primary outcome was IHF quantified by magnetic resonance spectroscopy (MRS). Secondary outcomes included insulin sensitivity (assessed by oral glucose tolerance), body composition (assessed by dual‐energy X‐ray absorptiometry), physical function (VO 2peak and strength), glucose, lipids, and blood pressure (BP). Body weight (D: −9 ± 1%, D+E: −10 ± 2%, both P < 0.05) and fat mass (D: −13 ± 3%, D+E −16 ± 3%, both P < 0.05) decreased in both groups but there was no difference between groups. IHF decreased to a similar extent in both groups (D: −46 ± 11%, D+E: −45 ± 8%, both P < 0.05), which was accompanied by comparable improvements in insulin sensitivity (D: 66 ± 25%, D+E: 68 ± 28%, both P < 0.05). The relative decreases in IHF correlated directly with relative increases in insulin sensitivity index (ISI) (r = −0.52; P < 0.05). Improvements in VO 2peak, strength, plasma triglyceride (TG), and low‐density lipoprotein–cholesterol concentration, and diastolic BP occurred in the D+E group (all P < 0.05) but not in the D group. Diet with or without exercise results in significant decreases in IHF content accompanied by considerable improvements in insulin sensitivity in obese older adults. The addition of exercise to diet therapy improves physical function and other obesity‐ and aging‐related metabolic abnormalities.

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  • A weight reduction of 5% or more brings further health benefits, such as preventing or resolving type 2 diabetes, lowering blood pressure and lipids, improving non-alcoholic fatty liver disease, and alleviating urinary incontinence and sexual dysfunction.

    “Weight loss of this size confers additional health benefits beyond those described above. These include prevention and resolution of type 2 diabetes,11,12 reduction in blood pressure and lipids,13–14 amelioration of non-alcoholic fatty liver disease,15 and improvements in urinary incontinence and sexual dysfunction.16,17”

    From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [15]

    The Discussion reports that approximately 9% weight loss in obese older adults reduced intrahepatic fat by about 50%, and that the prevalence of NAFLD fell during the intervention. This supports the NAFLD benefit for which this paper is cited, but does not establish that weight loss as low as 5% is sufficient. (LLM, conf=0.83)

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  • In ten trials, a weight-reducing diet alone resulted in the desired weight loss, which consisted of fat mass as well as lean mass.

    “In ten trials, a weight-reducing diet alone resulted in the desired weight loss, which consisted of fat mass as well as lean mass (290)(291)(292)(294)(295)(296)(297)(298)(299).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [292]

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  • Twelve RCTs compared the effects of a dietary weight loss intervention alone to a combination of the same dietary intervention with an exercise intervention in older persons.

    “Twelve RCTs were identified that compared the effects of a dietary weight loss intervention alone to a combination of the same dietary intervention with an exercise intervention in older persons (288)(289)(290)(291)(292)(293)(294)(295)(296)(297)(298)(299).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [292]

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Authors
Shah, K., Stufflebam, A., Hilton, T. N., Sinacore, D. R., Klein, S., & Villareal, D. T.
Affiliations
Washington University in St. Louis (US)
Corresponding author
Villareal, Dennis T.
ORCID
Venue
Obesity
Publisher
Wiley
Published
2009-12
Volume
17
Issue
12
Pages
2162-2168
ISSN
  • 1930-7381 (ISSN-L)
  • 1930-739X
DOI
10.1038/oby.2009.126
PMC
PMC2793412
OpenAlex
W2103749588
Cited by
194
References
52
Citations by year
2026: 2 · 2025: 7 · 2024: 6 · 2023: 10 · 2022: 7 · 2021: 8 · 2020: 3 · 2019: 9 · 2018: 11 · 2017: 16 · 2016: 17 · 2015: 14 · 2014: 17 · 2013: 16 · 2012: 22
FWCI
11.24
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1010 d)
Locations
  • Obesity (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000448, 7r01ag025501-06)
  • National Institute on Aging (R01-AG025501, AG-025501)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK37948, DK56341, R01DK037948, P30DK056341)
  • National Center for Research Resources (UL1RR024992)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
intrahepatic fat, non-alcoholic fatty liver disease, insulin sensitivity, older adults, dietary therapy, exercise intervention, weight loss, physical function, body composition, insulin resistance
MeSH terms
Adipose Tissue, Aged, Aged, 80 and over, Blood Glucose, Blood Pressure, Body Weight, Diet, Fatty Liver, Female, Humans, Insulin Resistance, Cholesterol, LDL, Male, Obesity, Oxygen Consumption, Physical Fitness, Triglycerides, Exercise, Treatment Outcome, Glucose Intolerance

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