Effect of sustained decreases in sedentary time and increases in physical activity on liver enzymes and indices in type 2 diabetes
Open accessAbstract
Background: Current guidelines for nonalcoholic fatty liver disease (NAFLD) recommend high volumes and/or intensities of physical activity (PA), the achievement of which generally requires participation in supervised exercise training programs that however are difficult to implement in routine clinical practice. Conversely, counselling interventions may be more suitable, but result in only modest increases in moderate-to-vigorous-intensity PA (MVPA). This study assessed whether a counseling intervention for increasing PA and decreasing sedentary time (SED-time) is effective in improving NAFLD markers in people with type 2 diabetes. Methods: Three-hundred physically inactive and sedentary patients were randomized 1:1 to receive one-month theoretical and practical counseling once-a-year (intervention group) or standard care (control group) for 3 years. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyltranspeptidase (γGT) levels were measured and fatty liver index (FLI), hepatic steatosis index (HSI), and visceral adiposity index (VAI) were calculated. Total PA volume, light-intensity PA (LPA), moderate-to-vigorous-intensity PA (MVPA), and SED-time were objectively measured by an accelerometer. Results: Throughout the 3-year period, NAFLD markers did not change in the control group, whereas ALT, γGT, FLI, and HSI decreased in the intervention group, with significant between-group differences, despite modest MVPA increases, which however were associated with larger decrements in SED-time and reciprocal increments in LPA. Mean changes in NAFLD markers varied according to quartiles of (and correlated with) changes in MVPA (all markers) and SED-time, LPA, and PA volume (ALT, γGT, and HSI). Mean changes in MVPA or PA volume were independent predictors of changes in NAFLD markers. When included in the models, change in cardiorespiratory fitness and lower body muscle strength were independently associated with some NAFLD markers. Conclusion: A behavior change involving all domains of PA lifestyle, even if insufficient to achieve the recommended MVPA target, may provide beneficial effects on NAFLD markers in people with type 2 diabetes.
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- Authors
- Haxhi, J., Vitale, M., Mattia, L., Giuliani, C., Sacchetti, M., Orlando, G., Iacobini, C., Menini, S., Zanuso, S., Nicolucci, A., Balducci, S., & Pugliese, G.
- Affiliations
- Azienda Ospedaliera Sant'Andrea (IT)
- Foro Italico University of Rome (IT)
- Manchester Metropolitan University (GB)
- Sapienza University of Rome (IT)
- Coventry (United Kingdom) (GB)
- Mario Negri Sud Foundation (IT)
- Corresponding author
- Pugliese, Giuseppe
- ORCID
- Venue
- Frontiers in Endocrinology
- Publisher
- Frontiers Media SA
- Published
- 2024-05-24
- Volume
- 15
- Pages
- 1393859-1393859
- ISSN
- 1664-2392 (ISSN-L)
- PMC
- PMC11157683
- OpenAlex
- W4398781764
- Cited by
- 5
- References
- 50
- Citations by year
- 2026: 3 · 2025: 2
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- e-space (Manchester Metropolitan University) (acceptedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, non-alcoholic fatty liver disease, sedentary behavior, physical activity, counseling intervention, liver enzymes, alanine aminotransferase, gamma-glutamyl transferase, fatty liver index, hepatic steatosis, visceral fat, cardiorespiratory fitness, muscle strength, light physical activity, accelerometer-measured activity
- MeSH terms
- Aged, Alanine Transaminase, Aspartate Aminotransferases, Diabetes Mellitus, Type 2, Female, gamma-Glutamyltransferase, Humans, Liver, Male, Middle Aged, Biomarkers, Exercise, Sedentary Behavior, Non-alcoholic Fatty Liver Disease
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