Exercise improves surrogate measures of liver histological response in metabolic dysfunction‐associated steatotic liver disease
Open accessAbstract
Background and Aims: Exercise is recommended for the management of metabolic dysfunction‐associated steatotic liver disease (MASLD), yet effects on liver histology remain unknown, especially without significant weight loss. We aimed to examine changes in surrogate measures of liver histological response with exercise training. Methods: We conducted a post hoc pooled analysis of three randomised controlled trials (duration: 12–20 weeks) comparing aerobic exercise interventions with controls. The primary outcome measure was a ≥30% relative reduction in (MRI‐measured) liver fat, as a surrogate measure of liver histological response (the threshold necessary for fibrosis improvement). Secondary outcome measures were changes in other biomarkers of liver fibrosis, anthropometry, body composition and aerobic fitness. Results: Eighty‐eight adults (exercise: 54, control: 34; male: 67%) were included with mean (SD) age 51 (11) years and body mass index 33.3 (5.2) kg/m 2 . Following the intervention, exercise had ~5‐fold (OR [95%CI]: 4.86 [1.72, 13.8], p = .002) greater odds of ≥30% relative reduction in MRI‐measured liver fat compared with control. This paralleled the improvements in anthropometry (waist and hip circumference reduction), body composition (body fat, visceral and subcutaneous adipose tissue) and aerobic fitness (V̇O 2 peak, ventilatory threshold and exercise capacity). Importantly, these effects were independent of clinically significant body weight loss (<3% body weight). Conclusion: Exercise training led to clinically meaningful improvements in surrogate serum‐ and imaging‐based measures of liver histological change, without clinically meaningful body weight reduction. These data reinforce the weight‐neutral benefit of exercise training and suggest that aerobic training may improve liver fibrosis in patients with MASLD.
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All RCTs on aerobic exercise showed no difference in liver fibrosis indices/stages between aerobic exercise and control.
“With regard aerobic exercise, all RCTs showed no difference between liver fibrosis indices/stages between the aerobic exercise group and the control group [68, 70, 72, 74, 75].”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [68]
The Results (Secondary outcomes; page unavailable) report no significant differences in clinical decision aids for liver disease severity between exercise and control in a pooled analysis of three RCTs. The paper does not report fibrosis-stage comparisons or establish that every individual RCT found no difference; it also reports improvement in other surrogate measures of fibrosis. (LLM, conf=0.85)
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- Authors
- Cuthbertson, D. J., Keating, S. E., Pugh, C. J. A., Owen, P. J., Kemp, G. J., Umpleby, M., Geyer, N. G., Chinchilli, V. M., & Stine, J. G.
- Affiliations
- University of Liverpool (GB)
- The University of Queensland (AU)
- Cardiff Metropolitan University (GB)
- Deakin University (AU)
- Diabetes and Metabolic Medicine University of Surrey Guildford UK
- Department of Public Health Sciences Penn State Health Milton S. Hershey Medical Center Hershey Pennsylvania USA
- Pennsylvania State University (US)
- Corresponding author
- Stine, Jonathan G.
- ORCID
- Venue
- Liver International
- Publisher
- Wiley
- Published
- 2024-06-07
- Volume
- 44
- Issue
- 9
- Pages
- 2368-2381
- ISSN
- 0106-9543 (ISSN-L)
- 1478-3223
- 1478-3231
- PMC
- PMC11365804
- OpenAlex
- W4399432225
- Cited by
- 38
- References
- 47
- Citations by year
- 2026: 18 · 2025: 19 · 2024: 1
- FWCI
- 11.60
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Liver International (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- Funders
- National Health and Medical Research Council (1122190)
- Pennsylvania Department of Health
- National Institutes of Health (L30 DK118601, UL1TR000127, UL1TR002014)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- non-alcoholic fatty liver disease, exercise training, aerobic exercise, liver fat reduction, liver fibrosis, surrogate markers, body composition, adipose tissue, cardiorespiratory fitness
- MeSH terms
- Adult, Body Composition, Exercise Therapy, Female, Humans, Liver, Liver Cirrhosis, Magnetic Resonance Imaging, Male, Middle Aged, Biomarkers, Exercise, Body Mass Index, Randomized Controlled Trials as Topic, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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