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Exercise Training Is Associated With Treatment Response in Liver Fat Content by Magnetic Resonance Imaging Independent of Clinically Significant Body Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis
Open accessAbstract
INTRODUCTION: Exercise training is crucial in the management of nonalcoholic fatty liver disease (NAFLD); however, whether it can achieve clinically meaningful improvement in liver fat is unclear. We investigated the association between exercise training and the achievement of validated thresholds of MRI-measured treatment response. METHODS: Randomized controlled trials in adults with NAFLD were identified through March 2022. Exercise training was compared with no exercise training. The primary outcome was ≥30% relative reduction in MRI-measured liver fat (threshold required for histologic improvement in nonalcoholic steatohepatitis activity, nonalcoholic steatohepatitis resolution, and liver fibrosis stage). Different exercise doses were compared. RESULTS: Fourteen studies (551 subjects) met inclusion criteria (mean age 53.3 yrs; body mass index 31.1 kg/m 2 ). Exercise training subjects were more likely to achieve ≥30% relative reduction in MRI-measured liver fat (odds ratio 3.51, 95% confidence interval 1.49–8.23, P = 0.004) than those in the control condition. An exercise dose of ≥750 metabolic equivalents of task min/wk (e.g., 150 min/wk of brisk walking) resulted in significant treatment response (MRI response odds ratio 3.73, 95% confidence interval 1.34–10.41, P = 0.010), but lesser doses of exercise did not. Treatment response was independent of clinically significant body weight loss (>5%). DISCUSSION: Independent of weight loss, exercise training is 3 and a half times more likely to achieve clinically meaningful treatment response in MRI-measured liver fat compared with standard clinical care. An exercise dose of at least 750 metabolic equivalents of task-min/wk seems required to achieve treatment response. These results further support the weight-neutral benefit of exercise in all patients with NAFLD.
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Self-citationAerobic Exercise Training Leads to MASH Resolution as Defined by the MASH Resolution Index
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Metadata
- Authors
- Stine, J. G., DiJoseph, K., Pattison, Z., Harrington, A., Chinchilli, V. M., Schmitz, K. H., & Loomba, R.
- Affiliations
- Pennsylvania State University (US)
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA;
- University of California San Diego (US)
- Corresponding author
- Stine, Jonathan G.
- Venue
- American Journal of Gastroenterology
- Published
- 2022-12-23
- Volume
- 118
- Issue
- 7
- Pages
- 1204-1213
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- PMC
- PMC10287833
- OpenAlex
- W4318263398
- Cited by
- 94
- References
- 34
- Citations by year
- 2026: 32 · 2025: 32 · 2024: 17 · 2023: 13
- FWCI
- 2.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- other-oa
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, other-oa)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- AstraZeneca
- Gilead Sciences
- Arrowhead Pharmaceuticals
- Novo Nordisk
- Grifols
- National Institutes of Health (UL1TR001442)
- National Institute on Alcohol Abuse and Alcoholism (U01AA029019)
- National Heart, Lung, and Blood Institute (P01HL147835)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124318, R01DK121378, R01DK106419, P30DK120515, K23DK131290, U01DK061734, U01DK130190)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- exercise training, non-alcoholic fatty liver disease, liver fat, treatment response, exercise dose, metabolic equivalents, weight loss, nonalcoholic steatohepatitis, liver fibrosis
- MeSH terms
- Adult, Humans, Liver, Magnetic Resonance Imaging, Middle Aged, Weight Loss, Exercise, Non-alcoholic Fatty Liver Disease
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