Physical activity intervention for non-diabetic patients with non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials.
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Abstract
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease nowadays. Changes in diet and lifestyle have led to a dramatic increase in the prevalence of NAFLD around the world. This meta-analysis is to investigate the efficacy of physical activity intervention on liver-specific endpoints in the population with NAFLD, including hepatic enzyme, serum lipid, glucose metabolism and intra-hepatic lipid. METHODS: PubMed and China National Knowledge Infrastructure (CNKI) databases were searched for randomized clinical trials of physical activity intervention on NAFLD patients through April 20th, 2019. Effect sizes were reported as standardized mean difference (SMD) and 95% confidence intervals (CI). Quality of included studies was assessed according to the Cochrane risk of bias tool. Meta-analyses were conducted using random-effect or fixed-effect models depending on the significance of heterogeneity. Subgroup analyses according to types and duration of physical activity were conducted to investigate clinical variability. RESULTS: Nine studies with a cumulative total of 951 participants met selection criteria. Physical activity was found associated with small reductions in hepatic enzyme parameters: ALT (SMD -0.17, 95% CI:-0.30 to - 0.05), AST (SMD -0.25, 95% CI: - 0.38, - 0.13) and GGT (SMD -0.22, 95% CI: - 0.36, - 0.08). Significant small improvements were also found in serum lipid parameters including TC (SMD = - 0.22, 95% CI: - 0.34, - 0.09), TG (SMD = - 0.18, 95% CI: - 0.31 to - 0.06) and LDL-C (SMD = - 0.26, 95% CI: - 0.39 to - 0.13). Significant improvement was also found in intra-hepatic lipid content (SMD = - 0.21, 95% CI: - 0.36 to - 0.06) There was no difference between physical intervention group and control group in HDL and three glucose metabolism parameters. Subgroup analysis suggested both aerobic exercise alone and resistance exercise alone can improve most liver function and longer period of exercise generally had better improvement effect. CONCLUSIONS: Our findings suggest that physical activity alone can only slightly improve hepatic enzyme levels, most serum lipid levels and intra-hepatic lipid content in non-diabetic patients with NAFLD.
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Physical activity has proven to be an effective intervention for treating and preventing NAFLD.
“Physical activity has proven to be an effective intervention for treating and preventing NAFLD”
From Effect of Exercise Training on Fat Loss—Energetic Perspectives and the Role of Improved Adipose Tissue Function and Body Fat Distribution (2021) · cites this paper as Wang et al., 2020
The Conclusions report small improvements in liver enzymes, serum lipids and intra-hepatic fat in non-diabetic patients with NAFLD, but caution against expecting great improvement from physical activity alone. The Background mentions an inverse relationship between physical activity and NAFLD risk; it does not establish that physical activity prevents NAFLD. Thus, “proven” overstates the paper’s qualified findings. (LLM, conf=0.90)
Experimental — accuracy not yet measuredA meta-analysis by Wang et al. in non-diabetic patients with MASLD showed that resistance training led to significant reductions in ALT and AST.
“In addition, a meta-analysis by Wang et al. [106] in non-diabetic patients with MASLD showed that resistance training led to significant reductions in ALT and AST.”
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 [106]
The Results section (no page supplied) reports a significant reduction in AST with resistance exercise alone (SMD −0.23, 95% CI −0.43 to −0.03). It reports a significant ALT reduction for physical activity overall, but does not report a significant ALT reduction specifically for resistance exercise. The claim therefore overstates the resistance-training finding. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Wang, S.-T., Zheng, J., Peng, H.-W., Cai, X.-L., Pan, X.-T., Li, H.-Q., Hong, Q.-Z., & Peng, X.-E.
- Affiliations
- Fujian Medical University (CN)
- Corresponding author
- Peng, Xian-E
- Venue
- BMC Gastroenterology
- Published
- 2020-03-12
- Volume
- 20
- Issue
- 1
- Pages
- 66-66
- ISSN
- 1471-230X (ISSN-L)
- PMC
- PMC7066783
- OpenAlex
- W3010751539
- Cited by
- 68
- References
- 33
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 8 · 2023: 8 · 2022: 11 · 2021: 21 · 2020: 8
- FWCI
- 1.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Gastroenterology (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (81473047)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- non-alcoholic fatty liver disease, physical activity interventions, aerobic exercise, resistance training, liver enzymes, serum lipids, intrahepatic lipid, glucose metabolism, exercise duration, lifestyle intervention, non-diabetic patients, liver function biomarkers, HDL cholesterol, triglycerides, LDL cholesterol, total cholesterol, gamma-glutamyl transferase, alanine aminotransferase
- MeSH terms
- Blood Glucose, Exercise Therapy, Humans, Lipids, Cholesterol, HDL, Liver, Exercise, Randomized Controlled Trials as Topic, Lipid Metabolism, Resistance Training, Non-alcoholic Fatty Liver Disease
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