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Keating SE, Sabag A, Hallsworth K, Hickman IJ, Macdonald GA, Stine JG, George J, Johnson NA. Exercise in the Management of Metabolic-Associated Fatty Liver Disease (MAFLD) in Adults: A Position Statement from Exercise and Sport Science Australia. Sports Med 2023; 53:2347-2371. [PMID: 37695493 PMCID: PMC10687186 DOI: 10.1007/s40279-023-01918-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
Metabolic-associated fatty liver disease (MAFLD) is the most prevalent chronic liver disease worldwide, affecting 25% of people globally and up to 80% of people with obesity. MAFLD is characterised by fat accumulation in the liver (hepatic steatosis) with varying degrees of inflammation and fibrosis. MAFLD is strongly linked with cardiometabolic disease and lifestyle-related cancers, in addition to heightened liver-related morbidity and mortality. This position statement examines evidence for exercise in the management of MAFLD and describes the role of the exercise professional in the context of the multi-disciplinary care team. The purpose of these guidelines is to equip the exercise professional with a broad understanding of the pathophysiological underpinnings of MAFLD, how it is diagnosed and managed in clinical practice, and to provide evidence- and consensus-based recommendations for exercise therapy in MAFLD management. The majority of research evidence indicates that 150-240 min per week of at least moderate-intensity aerobic exercise can reduce hepatic steatosis by ~ 2-4% (absolute reduction), but as little as 135 min/week has been shown to be effective. While emerging evidence shows that high-intensity interval training (HIIT) approaches may provide comparable benefit on hepatic steatosis, there does not appear to be an intensity-dependent benefit, as long as the recommended exercise volume is achieved. This dose of exercise is likely to also reduce central adiposity, increase cardiorespiratory fitness and improve cardiometabolic health, irrespective of weight loss. Resistance training should be considered in addition to, and not instead of, aerobic exercise targets. The information in this statement is relevant and appropriate for people living with the condition historically termed non-alcoholic fatty liver disease (NAFLD), regardless of terminology.
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Affiliation(s)
- Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Room 534, Bd 26B, St Lucia, Brisbane, QLD, 4067, Australia.
| | - Angelo Sabag
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Kate Hallsworth
- NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, PA-Southside Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, PA-Southside Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University- College of Medicine, Hershey, PA, USA
- Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Nathan A Johnson
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
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Physical Activity Is Associated With Nonalcoholic Fatty Liver Disease and Significant Fibrosis Measured by FibroScan. Clin Gastroenterol Hepatol 2022; 20:e1438-e1455. [PMID: 34214678 DOI: 10.1016/j.cgh.2021.06.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Studies evaluating the association of 2018 Physical Activity Guidelines for Americans (PA Guidelines) with nonalcoholic fatty liver disease (NAFLD) and significant fibrosis or cirrhosis are needed. We evaluated the association of meeting PA Guidelines with NAFLD and significant fibrosis or cirrhosis by transient elastography in the United States. METHODS A cross-sectional analysis was performed using the 2017-2018 U.S. National Health and Nutrition Examination Survey data. NAFLD and significant fibrosis or cirrhosis were defined by transient elastography in the absence of other causes of chronic liver disease. The detailed PA questionnaire assessed the leisure-time, occupation-related, and transportation-related PA. PA was categorized based on the PA Guidelines. RESULTS Of the 4304 subjects, leisure-time PA, which met the PA Guidelines (≥150 min/wk), was associated with 44% lower risk of NAFLD (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.46-0.67). Subjects who reported 1-2 times (150-299 min/wk) or over 2 times (≥300 min/wk) the recommended amount of PA Guidelines had 40% (OR, 0.60; 95% CI, 0.41-0.90) and 49% (OR, 0.51; 95% CI, 0.40-0.65) lower odds of NAFLD, respectively. Over 8 hours of sitting time had a 44% higher risk of NAFLD (OR, 1.44; 95% CI, 1.01-2.05) when we considered leisure-time PA and sitting time simultaneously. Over 2 times (≥300 min/wk) the recommended amount of PA Guidelines for leisure-time PA had 59% (OR, 0.41; 95% CI, 0.22-0.74) lower risk for significant fibrosis and 63% (OR, 0.37; 95% CI, 0.21-0.64) lower odds of cirrhosis. CONCLUSIONS Meeting PA Guidelines for leisure-time PA has beneficial effects on NAFLD, and over 2 times the recommended amount of PA Guidelines had lower risk for significant fibrosis or cirrhosis.
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Liu Q, Li H, He W, Zhao Q, Huang C, Wang Q, Zheng Z, Zhang X, Shi X, Li X. Role of aerobic exercise in ameliorating NASH: Insights into the hepatic thyroid hormone signaling and circulating thyroid hormones. Front Endocrinol (Lausanne) 2022; 13:1075986. [PMID: 36605939 PMCID: PMC9807753 DOI: 10.3389/fendo.2022.1075986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
AIM Triiodothyronine (T3) administration significantly eliminates hepatic steatosis and also has a therapeutic effect on non-alcoholic steatohepatitis (NASH). However, the potential mechanism by which T3-mediated exercise improves NASH is unknow. This study aimed to explore the effect of aerobic exercise on liver injury in NASH. METHODS Aerobic exercise was conducted to explore the effects of exercise on liver injury in NASH model induced by Atherosclerotic (Ath) diet. Biochemical evaluations, histological staining and real-time PCR were first applied to confirm the amelioration effects of exercise on NASH. RNA-sequencing (RNA-seq) analysis for livers of each group were further used to identify the underlying mechanisms of aerobic exercise. Bioinformatics methods were used to explore the key functional pathways involved in the improvement of liver tissue in NASH mice by aerobic exercise. RESULTS Aerobic exercise improved hepatic steatosis, lobular inflammation and fibrosis in NASH mice. multiple inflammation-related pathways were significantly enriched in the liver of NASH group and improved by aerobic exercise. The results of gene set variation analysis (GSVA) showed a higher enrichment score of T3 response signature in NASH mice with exercise. Increased Dio1 expression in the liver of NASH with exercise mice and increased circulating FT3 and FT4 levels upon aerobic exercise were confirmed. CONCLUSIONS We found that aerobic exercise could significantly reduce hepatic lipid accumulation, inflammatory infiltration and fibrosis progression in the liver of NASH mice. Hepatic thyroid hormone signaling activation and circulating thyroid hormones is potentially involved in the amelioration effect of aerobatic exercise on NASH progression.
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Affiliation(s)
- Qiuhong Liu
- School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Han Li
- School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Weiwei He
- School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qing Zhao
- School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Caoxin Huang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qingxuan Wang
- School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zeyu Zheng
- School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaofang Zhang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiulin Shi
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Xuejun Li, ; Xiulin Shi,
| | - Xuejun Li
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Xuejun Li, ; Xiulin Shi,
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Kamada Y, Takahashi H, Shimizu M, Kawaguchi T, Sumida Y, Fujii H, Seko Y, Fukunishi S, Tokushige K, Nakajima A, Okanoue T. Clinical practice advice on lifestyle modification in the management of nonalcoholic fatty liver disease in Japan: an expert review. J Gastroenterol 2021; 56:1045-1061. [PMID: 34718870 DOI: 10.1007/s00535-021-01833-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/01/2021] [Indexed: 02/04/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver diseases worldwide, including in Japan. The Japanese Society of Gastroenterology (JSGE) and the Japanese Society of Hepatology (JSH) have established the Japanese NAFLD/NASH guidelines in 2014 and revised these guidelines in 2020. As described in these guidelines, weight reduction by diet and/or exercise therapy is important for the treatment of NAFLD patients. The I148M single nucleotide polymorphism (rs738409 C > G) of PNPLA3 (patatin-like phospholipase domain-containing 3 protein) is widely known to be associated with the occurrence and progression of NAFLD. In the Japanese, the ratio of PNPLA3 gene polymorphisms found is approximately 20%, which is higher than that found in Westerners. In addition, the ratio of lean NAFLD patients is also higher in Japan than in Western countries. Therefore, the method for lifestyle guidance for the NAFLD patients in Japan would be different from that for the people in Western countries. The problems in the treatment of NAFLD patients include alcohol consumption and sarcopenia. Therefore, guidelines that can help clinicians treat Japanese patients with NAFLD are needed. In this expert review, we summarize evidence-based interventions for lifestyle modification (diet, exercise, alcohol, and sarcopenia) for the treatment of patients with NAFLD, especially from Japan and Asian countries.
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Affiliation(s)
- Yoshihiro Kamada
- Department of Advanced Metabolic Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
| | - Hirokazu Takahashi
- Department of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, 840-8502, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, 830-0011, Japan
| | - Yoshio Sumida
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Hideki Fujii
- Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan
| | - Yuya Seko
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Shinya Fukunishi
- Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, 569-8686, Japan
| | - Katsutoshi Tokushige
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, 1-2 Kawazonocho, Suita, Osaka, 564-0013, Japan
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Yamamura S, Kawaguchi T, Nakano D, Tomiyasu Y, Yoshinaga S, Doi Y, Takahashi H, Anzai K, Eguchi Y, Torimura T. Prevalence and Independent Factors for Fatty Liver and Significant Hepatic Fibrosis Using B-Mode Ultrasound Imaging and Two Dimensional-Shear Wave Elastography in Health Check-up Examinees. Kurume Med J 2021; 66:225-237. [PMID: 34690209 DOI: 10.2739/kurumemedj.ms664008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Exercise is beneficial for metabolic syndrome. Fatty liver and significant hepatic fibrosis, hepatic manifestations of metabolic syndrome, are becoming an epidemic. We aimed to investigate the prevalence of fatty liver and significant fibrosis and examined the independent factors for these conditions. SUBJECTS AND METHODS We enrolled 1,361 health check-up examinees (median age, 53 years; female/male, 813/548). Fatty liver and fibrosis were evaluated by B-mode ultrasound imaging and shear wave elastography. Factors associated with fatty liver and significant fibrosis were analyzed by logistic regression analysis. RESULTS Fatty liver and significant fibrosis were observed in 50.5% and 42.7% of enrolled subjects, respectively. Independent factors associated with fatty liver were BMI (OR 1.46; 95%CI 1.397-1.537; P<0.0001) and no exer cise habits (OR 1.47; 95% CI 1.101-1.984; P=0.0093). Independent factors associated with significant fibrosis were age, female, BMI (OR 1.37; 95%CI 1.311-1.436; P<0.0001), and no exercise habits (OR 1.49; 95% CI 1.102-2.031; P=0.0097). CONCLUSIONS Fatty liver and significant fibrosis were frequently seen in health check-up examinees and the common independent factors were higher BMI and no exercise habits. Thus, weight loss and exercise may ameliorate fatty liver and significant hepatic fibrosis in the general population.
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Affiliation(s)
- Sakura Yamamura
- Division of Gastroenterology, Department of Internal Medicine, Kurume University School of Medicine
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Internal Medicine, Kurume University School of Medicine
| | - Dan Nakano
- Division of Gastroenterology, Department of Internal Medicine, Kurume University School of Medicine
| | - Yoshiko Tomiyasu
- Medical Examination Section, Medical Examination Part Facilities, Public Utility Foundation Saga Prefectural Health Promotion Foundation
| | - Shinobu Yoshinaga
- Medical Examination Section, Medical Examination Part Facilities, Public Utility Foundation Saga Prefectural Health Promotion Foundation
| | - Yumi Doi
- Medical Examination Section, Medical Examination Part Facilities, Public Utility Foundation Saga Prefectural Health Promotion Foundation
| | - Hirokazu Takahashi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga University Hospital
| | - Keizo Anzai
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga University Hospital
| | - Yuichiro Eguchi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga University Hospital.,Liver Center, Saga University Hospital
| | - Takuji Torimura
- Division of Gastroenterology, Department of Internal Medicine, Kurume University School of Medicine
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Sung MJ, Lim TS, Jeon MY, Lee HW, Kim BK, Kim DY, Ahn SH, Han KH, Park JY, Kim SU. Sarcopenia Is Independently Associated with the Degree of Liver Fibrosis in Patients with Type 2 Diabetes Mellitus. Gut Liver 2021; 14:626-635. [PMID: 32135582 PMCID: PMC7492504 DOI: 10.5009/gnl19126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/26/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Sarcopenia is associated with liver fibrosis in patients with nonalcoholic fatty liver disease and chronic hepatitis B. We investigated the association between sarcopenia and hepatic fibrotic burden in patients with type 2 diabetes mellitus (T2DM). Methods Patients with T2DM who had received a comprehensive medical health check-up were recruited. Muscle mass was assessed using computed tomography. Fibrotic burden was assessed using the fibrosis-4 index (FIB-4). The study population was divided by quartile stratification of the lumbar skeletal muscle index (LSMI). Results Among 309 patients with T2DM, 75 (24.3%) had sarcopenia. These patients were significantly older and had higher FIB-4, whereas they had significantly lower body mass index (BMI) and LSMI than patients without sarcopenia (all p<0.05). The LSMI showed a significant negative correlation with the FIB-4 when analyzed in terms of quartile stratification (p=0.003). Multivariate analysis showed that female sex and higher BMI were independently associated with a reduced risk of sarcopenia (odds ratio [OR], 0.388; 95% confidence interval [CI], 0.199 to 0.755 and OR, 0.704; 95% CI, 0.618 to 0.801; all p<0.05), whereas a higher FIB-4 was independently associated with an increased risk of sarcopenia (OR, 1.817; 95% CI, 1.180 to 2.797; p=0.007). Among patients with a BMI <25 kg/m2 (n=165), those with sarcopenia (n=54, 32.7%) had a significantly higher FIB-4 than those without (n=111, 67.3%; 1.66 vs 1.38, p=0.004). Conclusions Sarcopenia is independently associated with fibrotic burden in patients with T2DM. Further studies should investigate whether the improvement of sarcopenia can ameliorate liver fibrosis in patients with T2DM.
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Affiliation(s)
- Min Je Sung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Seop Lim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Mi Young Jeon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Hashida R, Nakano D, Yamamura S, Kawaguchi T, Tsutsumi T, Matsuse H, Takahashi H, Gerber L, Younossi ZM, Torimura T. Association between Activity and Brain-Derived Neurotrophic Factor in Patients with Non-Alcoholic Fatty Liver Disease: A Data-Mining Analysis. Life (Basel) 2021; 11:799. [PMID: 34440543 PMCID: PMC8401718 DOI: 10.3390/life11080799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 02/08/2023] Open
Abstract
Reduction in activity links to the development and progression of non-alcoholic fatty liver disease (NAFLD). Brain-derived neurotrophic factor (BDNF) is known to regulate an activity. We aimed to investigate the association between reduction in activity and BDNF in patients with NAFLD using data-mining analysis. We enrolled 48 NAFLD patients. Patients were classified into reduced (n = 21) or normal activity groups (n = 27) based on the activity score of the Chronic Liver Disease Questionnaire-NAFLD/non-alcoholic steatohepatitis. Circulating BDNF levels were measured using an enzyme-linked immunoassay. Factors associated with reduced activity were analyzed using decision-tree and random forest analyses. A reduction in activity was seen in 43.8% of patients. Hemoglobin A1c and BDNF were identified as negative independent factors for reduced activity (hemoglobin A1c, OR 0.012, p = 0.012; BDNF, OR 0.041, p = 0.039). Decision-tree analysis showed that "BDNF levels ≥ 19.1 ng/mL" was the most important classifier for reduced activity. In random forest analysis, serum BDNF level was the highest-ranked variable for distinguishing between the reduced and normal activity groups (158 valuable importance). Reduced activity was commonly seen in patients with NAFLD. Data-mining analyses revealed that BNDF was the most important independent factor corresponding with the reduction in activity. BDNF may be an important target for the prevention and treatment of NAFLD.
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Affiliation(s)
- Ryuki Hashida
- Division of Rehabilitation, Kurume University Hospital, Kurume 830-0011, Japan; (R.H.); (H.M.)
- Department of Orthopedics, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Dan Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (D.N.); (S.Y.); (T.T.); (T.T.)
| | - Sakura Yamamura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (D.N.); (S.Y.); (T.T.); (T.T.)
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (D.N.); (S.Y.); (T.T.); (T.T.)
| | - Tsubasa Tsutsumi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (D.N.); (S.Y.); (T.T.); (T.T.)
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital, Kurume 830-0011, Japan; (R.H.); (H.M.)
- Department of Orthopedics, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Hirokazu Takahashi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 840-8502, Japan;
| | - Lynn Gerber
- Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA 22042, USA; (L.G.); (Z.M.Y.)
| | - Zobair M. Younossi
- Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA 22042, USA; (L.G.); (Z.M.Y.)
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (D.N.); (S.Y.); (T.T.); (T.T.)
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Iwanaga S, Hashida R, Takano Y, Bekki M, Nakano D, Omoto M, Nago T, Kawaguchi T, Matsuse H, Torimura T, Shiba N. Hybrid Training System Improves Insulin Resistance in Patients with Nonalcoholic Fatty Liver Disease: A Randomized Controlled Pilot Study. TOHOKU J EXP MED 2021; 252:23-32. [PMID: 32863329 DOI: 10.1620/tjem.252.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Insulin resistance is associated with the progression of nonalcoholic fatty liver disease (NAFLD). Insulin resistance is regulated by various cytokines, including interleukin-6 (IL-6), a proinflammatory myokine, and selenoprotein P (SeP), a liver-derived secretory hepatokine. High levels of IL-6 and/or SeP have been shown to contribute to insulin resistance, and exercise is a first-line therapy for NAFLD. We have developed a hybrid training system (HTS): a neuromuscular electrical stimulation device to enhance exercise results. We aimed to investigate the effects of HTS on insulin resistance as well as serum IL-6 and SeP in patients with NAFLD. This is a randomized, single-blind (assessor), controlled trial. Subjects with NAFLD walked on a treadmill with or without HTS (9 subjects each) for 30 minutes three times a week for six weeks (HTS vs. control group; median age 45 vs. 45; male/female 5/4 vs. 6/3). We examined subjects before the first session and at the end of the final session. Serum SeP levels were measured by ELISA which measures the fragment of SeP. In the HTS group, HOMA-IR values were significantly reduced compared to the control group (Δ-0.71 vs. Δ0.05; P < 0.05). IL-6 and SeP levels in serum were also significantly reduced compared to that of the control group (IL-6; Δ-0.6 vs. Δ0.29 pg/mL; P < 0.05, SeP; Δ-1288.5 vs. Δ-435.4 ng/mL; P < 0.05, respectively). In conclusion, we propose that HTS improves insulin resistance by reducing serum IL-6 and SeP levels in patients with NAFLD.
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Affiliation(s)
- Sohei Iwanaga
- Division of Rehabilitation, Kurume University Hospital.,Department of Orthopedics, Kurume University School of Medicine
| | - Ryuki Hashida
- Division of Rehabilitation, Kurume University Hospital.,Department of Orthopedics, Kurume University School of Medicine
| | - Yoshio Takano
- Department of Physical Therapy School of Health Sciences at Fukuoka, International University Health and Welfare
| | - Masafumi Bekki
- Division of Rehabilitation, Kurume University Hospital.,Department of Orthopedics, Kurume University School of Medicine
| | - Dan Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
| | - Masayuki Omoto
- Division of Rehabilitation, Kurume University Hospital.,Department of Orthopedics, Kurume University School of Medicine
| | - Takeshi Nago
- Division of Rehabilitation, Kurume University Hospital.,Department of Orthopedics, Kurume University School of Medicine
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital.,Department of Orthopedics, Kurume University School of Medicine
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
| | - Naoto Shiba
- Division of Rehabilitation, Kurume University Hospital.,Department of Orthopedics, Kurume University School of Medicine
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9
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Hashida R, Matsuse H, Kawaguchi T, Yoshio S, Bekki M, Iwanaga S, Sugimoto T, Hara K, Koya S, Hirota K, Nakano D, Tsutsumi T, Kanto T, Torimura T, Shiba N. Effects of a low-intensity resistance exercise program on serum miR-630, miR-5703, and Fractalkine/CX3CL1 expressions in subjects with No exercise habits: A preliminary study. Hepatol Res 2021; 51:823-833. [PMID: 34014020 DOI: 10.1111/hepr.13670] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022]
Abstract
AIMS Exercise is effective for the prevention of liver cancer. Exercise exerts biological effects through the regulation of microRNAs (miRNAs) and cytokines/myokines. We aimed to investigate the effects of low-intensity resistance exercise on serum miRNA and cytokine/myokine expressions in subjects with no exercise habits. METHODS We enrolled seven male subjects with no exercise habits in this prospective before-after study. All subjects performed a low-intensity resistance exercise program (three metabolic equivalents, approximately 20 min/session). Serum miRNA expressions were evaluated using microarrays. We performed Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of differentially expressed miRNAs before and after exercise. Serum cytokine/myokine expressions were evaluated using a multiplex panel. RESULTS All subjects completed the exercise program with no adverse events. In the microarray analysis, seven miRNAs showed a significant change between before and after exercise. Of these, microRNA (miR)-630 and miR-5703 showed a >1.5-fold increase (miR-630: 40.7 vs. 69.3 signal intensity, p = 0.0133; miR-5703: 30.7 vs. 55.9 signal intensity, p = 0.0051). KEGG pathway enrichment analysis showed that miR-630- and miR-5703-related genes were enriched in 37 and 5 pathways, including transforming growth factor-beta and Wnt signaling pathways, respectively. In the multiplex analysis, 12 cytokines/myokines showed significant alteration after exercise compared to before exercise. Of these, fractalkine/CX3CL1 showed the most significant up-regulation by exercise (94.5 vs. 109.1 pg/ml, p = 0.0017). CONCLUSIONS A low-intensity resistance exercise program was associated with upregulation of serum miR-630, miR-5703, and fractalkine/CX3CL1 expressions in subjects with no exercise habits. Thus, even low-intensity exercise may alter miRNA and cytokine/myokine expressions in humans.
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Affiliation(s)
- Ryuki Hashida
- Department of Orthopedics, School of Medicine, Kurume University, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, Kurume, Japan
| | - Hiroo Matsuse
- Department of Orthopedics, School of Medicine, Kurume University, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, Kurume, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Sachiyo Yoshio
- Department of Liver Disease, Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Masafumi Bekki
- Department of Orthopedics, School of Medicine, Kurume University, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, Kurume, Japan
| | - Sohei Iwanaga
- Department of Orthopedics, School of Medicine, Kurume University, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, Kurume, Japan
| | - Takahiro Sugimoto
- Division of Rehabilitation, Kurume University Hospital, Kurume, Japan
| | - Koji Hara
- Department of Orthopedics, School of Medicine, Kurume University, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, Kurume, Japan
| | - Shunji Koya
- Division of Rehabilitation, Kurume University Hospital, Kurume, Japan
| | - Keisuke Hirota
- Division of Rehabilitation, Kurume University Hospital, Kurume, Japan
| | - Dan Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tsubasa Tsutsumi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuya Kanto
- Department of Liver Disease, Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Naoto Shiba
- Department of Orthopedics, School of Medicine, Kurume University, Kurume, Japan
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10
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Bekki M, Matsuse H, Hashida R, Nago T, Iwanaga S, Kawaguchi T, Takano Y, Shiba N. Electrically Stimulated Eccentric Contractions during Walking Increases Oxygen Uptake. Kurume Med J 2021; 66:93-100. [PMID: 34135203 DOI: 10.2739/kurumemedj.ms662008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Neuromuscular electrical stimulation (NMES) is used to increase not only muscle strength but also whole-body metabolism. A hybrid training system (HTS) in which NMES is synchronized to voluntary exercise by an articular motion sensor may increase exercise load during aerobic walking exercise. We assessed the metabolic cost during walking exercise (5 minutes at 4 km/h and 5.6 km/h) on a treadmill simultaneously combined with HTS (HTSW) or without HTS (CON). We evaluated oxygen uptake ( VO·2) and heart rate (HR) during HTSW or CON on different days in fifteen subjects. The values ofVO·2 during HTSW at 4 km/h and 5.6 km/h were signifi cantly greater than those during CON (16.6 ± 1.85 ml/min/kg vs 15.3 ± 1.48 ml/min/kg; p < 0.05, 21.0 ± 2.17 ml/min/kg vs 19.4 ± 2.13 ml/min/kg; p < 0.01, respectively). The values of HR during HTSW at 4 km/h, 5.6 km/h were significantly greater than those during CON (106.7 ± 8.1 bpm vs 101.7 ± 10.3 bpm; p < 0.05, 126.5 ± 11.1 bpm vs 121.5 ± 12.5 bpm; p < 0.05, respectively). HTS added significantly to the exercise load by 8.3 ± 12.0% or 9.1 ± 9.9% during aerobic walking exercise at 4 km/h or 5.6 km/h, respectively. HTS might be useful for health promotion by increasing metabolic cost during aerobic walking exercise without increasing the perceived difficulty.
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Affiliation(s)
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital
| | - Ryuki Hashida
- Division of Rehabilitation, Kurume University Hospital
| | - Takeshi Nago
- Division of Rehabilitation, Kurume University Hospital
| | - Sohei Iwanaga
- Division of Rehabilitation, Kurume University Hospital
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
| | - Yoshio Takano
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare
| | - Naoto Shiba
- Division of Rehabilitation, Kurume University Hospital
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11
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Physiopathology of Lifestyle Interventions in Non-Alcoholic Fatty Liver Disease (NAFLD). Nutrients 2020; 12:nu12113472. [PMID: 33198247 PMCID: PMC7697937 DOI: 10.3390/nu12113472] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a major health problem, and its prevalence has increased in recent years. Diet and exercise interventions are the first-line treatment options, with weight loss via a hypocaloric diet being the most important therapeutic target in NAFLD. However, most NAFLD patients are not able to achieve such weight loss. Therefore, the requisite is the investigation of other effective therapeutic approaches. This review summarizes research on understanding complex pathophysiology underlying dietary approaches and exercise interventions with the potential to prevent and treat NAFLD.
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12
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Xu Y, Guan Y, Jin W, Ding L, Wu J. WITHDRAWN: Higher appendicular skeletal muscle mass percentage is an independent protective factor for non-alcoholic steatohepatitis and significant fibrosis in male with NAFLD. GASTROENTEROLOGIA Y HEPATOLOGIA 2020:S0210-5705(20)30253-3. [PMID: 32893039 DOI: 10.1016/j.gastrohep.2020.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/31/2019] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Yilun Xu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
| | - Yaqi Guan
- Wenzhou Medical University, Faculty of Nursing, Wenzhou 325000, Zhejiang province, China
| | - Wenyi Jin
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
| | - Li Ding
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China
| | - Jinming Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang province, China.
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13
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Singh AK, Kaur N, Kaushal S, Tyagi R, Mathur D, Sivapuram MS, Metri K, Bammidi S, Podder V, Modgil S, Khosla R, Sharma K, Anand A, Malik N, Boroiah V, Nagarathna R, Nagendra HR, Anand A. Partitioning of radiological, stress and biochemical changes in pre-diabetic women subjected to Diabetic Yoga Protocol. Diabetes Metab Syndr 2019; 13:2705-2713. [PMID: 31405697 DOI: 10.1016/j.dsx.2019.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Yoga is an ancient system of wellness with Asana and Pranayama as its most popular and propagated modules for management of lifestyle disorders. OBJECTIVES The aim of the study was to characterise the liver abnormalities, biochemical changes, and stress levels after Yoga intervention in prediabetic females. MATERIALS AND METHODS 37 females were randomly divided into Yoga practising and non-practising control groups. The Yoga practising group performed Diabetic Yoga Protocol (DYP) for 3 months. Parameters including size of liver, fatty infiltration, and grade of severity were measured using ultrasonography along with biochemical parameters and stress levels at baseline and after Yoga practice. RESULTS The glycosylated hemoglobin (HbA1c) and glucose levels were found significantly reduced in prediabetic (p = 0.015) women after practising DYP, although cholesterol levels increased in menopausal women. No escalation of fatty liver was noted among women practising DYP. CONCLUSION DYP reduced the HbA1c and stress levels and therefore, could be a cost-effective tool for preventing prediabetes to diabetes progression.
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Affiliation(s)
- Amit Kumar Singh
- Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, 560019, India
| | - Navneet Kaur
- Department of Physical Education, Panjab University, Chandigarh, 160014, India
| | - Sushant Kaushal
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160014, India
| | - Rahul Tyagi
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160014, India
| | - Deepali Mathur
- School of Biotechnology, KIIT, Bhubaneswar, 751024, Odisha, India
| | - Madhava Sai Sivapuram
- Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, China-outapalli, 521286, India
| | - Kashinath Metri
- Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, 560019, India
| | - Sridhar Bammidi
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160014, India
| | - Vivek Podder
- Kamineni Institute of Medical Sciences (KIMS), Narketpally, Nalgonda, 508254, India
| | - Shweta Modgil
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160014, India
| | - Radhika Khosla
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160014, India
| | - Kiran Sharma
- Yoga Federation of India, Chandigarh, 160014, India
| | | | - Neeru Malik
- Dev Samaj College of Education, Panjab University, Chandigarh, 160036, India
| | | | - Raghuram Nagarathna
- Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, 560019, India
| | | | - Akshay Anand
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160014, India.
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14
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Farzanegi P, Dana A, Ebrahimpoor Z, Asadi M, Azarbayjani MA. Mechanisms of beneficial effects of exercise training on non-alcoholic fatty liver disease (NAFLD): Roles of oxidative stress and inflammation. Eur J Sport Sci 2019; 19:994-1003. [PMID: 30732555 DOI: 10.1080/17461391.2019.1571114] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Parvin Farzanegi
- Department of Exercise Physiology, Sari Branch, Islamic Azad University, Sari, Iran
| | - Amir Dana
- Department of Physical Education, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Zeynab Ebrahimpoor
- Department of Exercise Physiology, Qaemshahr Branch, Islamic Azad University, Qaemshahr, Iran
| | - Mahdieh Asadi
- Department of Exercise Physiology, Sari Branch, Islamic Azad University, Sari, Iran
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15
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Guzmán-González B, Llanos P, Calatayud J, Maffiuletti NA, Cruz-Montecinos C. Effect of neuromuscular electrical stimulation frequency on postprandial glycemia, current-related discomfort, and muscle soreness. A crossover study. Appl Physiol Nutr Metab 2019; 44:834-839. [PMID: 30620614 DOI: 10.1139/apnm-2018-0801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Consensus is lacking regarding optimal neuromuscular electrical stimulation (NMES) parameters for postprandial glycemic control. Therefore, the aim of this study was to determine the NMES frequency inducing the greatest hypoglycemic effect in healthy individuals. The secondary aim was to compare current-related discomfort and muscle soreness between different frequencies. We conducted an experimental clinical study with a randomized crossover design. Sixteen healthy and sedentary participants received NMES for 20 min at 5, 10, or 50 Hz (pulse duration: 400 μs, on-off ratio: 4:12 s) following a standardized meal. Glycemia, discomfort, and muscle soreness during and after NMES were compared between conditions. Five-hertz NMES generated a significant hypoglycemic effect, contrary to 10 Hz and 50 Hz. Ten-hertz and 50-Hz NMES resulted respectively in lower current-related discomfort and greater muscle soreness compared with the other frequencies. Women reported higher discomfort than men. These findings contribute towards the possibility of more efficient long-term NMES treatments in terms of glycemic response and patient tolerance.
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Affiliation(s)
- Benjamín Guzmán-González
- a Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Pablo Llanos
- b Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Joaquín Calatayud
- c Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain; National Research Centre for the Working Environment, Copenhagen 2100, Denmark
| | | | - Carlos Cruz-Montecinos
- e Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile.,f Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago 8380419, Chile
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16
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Abstract
The increasing prevalence of obesity has made nonalcoholic fatty liver disease (NAFLD) the most common chronic liver disease. As a consequence, NAFLD and especially its inflammatory form nonalcoholic steatohepatitis (NASH) are the fastest increasing etiology of end-stage liver disease and hepatocellular carcinoma. Physical inactivity is related to the severity of fatty liver disease irrespective of body weight, supporting the hypothesis that increasing physical activity through exercise can improve fatty liver disease. This review summarizes the evidence for the effects of physical exercise on NAFLD and NASH. Several clinical trials have shown that both aerobic and resistance exercise reduce the hepatic fat content. From clinical and basic scientific studies, it is evident that exercise affects fatty liver disease through various pathways. Improved peripheral insulin resistance reduces the excess delivery of free fatty acids and glucose for free fatty acid synthesis to the liver. In the liver, exercise increases fatty acid oxidation, decreases fatty acid synthesis, and prevents mitochondrial and hepatocellular damage through a reduction of the release of damage-associated molecular patterns. In conclusion, physical exercise is a proven therapeutic strategy to improve fatty liver disease.
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Affiliation(s)
- Dirk J. van der Windt
- *Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- †Pittsburgh Liver Research Center (PLRC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Vikas Sud
- *Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- †Pittsburgh Liver Research Center (PLRC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Hongji Zhang
- *Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- †Pittsburgh Liver Research Center (PLRC), University of Pittsburgh, Pittsburgh, PA, USA
- ‡Department of Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Allan Tsung
- *Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- †Pittsburgh Liver Research Center (PLRC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Hai Huang
- *Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- †Pittsburgh Liver Research Center (PLRC), University of Pittsburgh, Pittsburgh, PA, USA
- ‡Department of Surgery, Union Hospital, Huazhong University of Science and Technology, Wuhan, P.R. China
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17
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Adejumo AC, Alliu S, Ajayi TO, Adejumo KL, Adegbala OM, Onyeakusi NE, Akinjero AM, Durojaiye M, Bukong TN. Cannabis use is associated with reduced prevalence of non-alcoholic fatty liver disease: A cross-sectional study. PLoS One 2017; 12:e0176416. [PMID: 28441459 PMCID: PMC5404771 DOI: 10.1371/journal.pone.0176416] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/09/2017] [Indexed: 12/24/2022] Open
Abstract
Cannabis use is associated with reduced prevalence of obesity and diabetes mellitus (DM) in humans and mouse disease models. Obesity and DM are a well-established independent risk factor for non-alcoholic fatty liver disease (NAFLD), the most prevalent liver disease globally. The effects of cannabis use on NAFLD prevalence in humans remains ill-defined. Our objective is to determine the relationship between cannabis use and the prevalence of NAFLD in humans. We conducted a population-based case-control study of 5,950,391 patients using the 2014 Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Survey (NIS) discharge records of patients 18 years and older. After identifying patients with NAFLD (1% of all patients), we next identified three exposure groups: non-cannabis users (98.04%), non-dependent cannabis users (1.74%), and dependent cannabis users (0.22%). We adjusted for potential demographics and patient related confounders and used multivariate logistic regression (SAS 9.4) to determine the odds of developing NAFLD with respects to cannabis use. Our findings revealed that cannabis users (dependent and non-dependent) showed significantly lower NAFLD prevalence compared to non-users (AOR: 0.82[0.76-0.88]; p<0.0001). The prevalence of NAFLD was 15% lower in non-dependent users (AOR: 0.85[0.79-0.92]; p<0.0001) and 52% lower in dependent users (AOR: 0.49[0.36-0.65]; p<0.0001). Among cannabis users, dependent patients had 43% significantly lower prevalence of NAFLD compared to non-dependent patients (AOR: 0.57[0.42-0.77]; p<0.0001). Our observations suggest that cannabis use is associated with lower prevalence of NAFLD in patients. These novel findings suggest additional molecular mechanistic studies to explore the potential role of cannabis use in NAFLD development.
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Affiliation(s)
- Adeyinka Charles Adejumo
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Biomedical Engineering & Biotechnology Program, University of Massachusetts Lowell, Lowell Massachusetts, United States of America
| | - Samson Alliu
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, United States of America
| | - Tokunbo Opeyemi Ajayi
- Johns Hopkins Medicine, Howard County General Hospital, Columbia, Maryland, United States of America
| | | | - Oluwole Muyiwa Adegbala
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, United States of America
| | | | - Akintunde Micheal Akinjero
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, United States of America
| | - Modupeoluwa Durojaiye
- Department of Maternal and Child Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Terence Ndonyi Bukong
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- INRS-Institut Armand-Frappier, Institut National de la Reserche Scientifique, Laval, Quebec, Canada
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18
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Lee YH, Kim SU, Song K, Park JY, Kim DY, Ahn SH, Lee BW, Kang ES, Cha BS, Han KH. Sarcopenia is associated with significant liver fibrosis independently of obesity and insulin resistance in nonalcoholic fatty liver disease: Nationwide surveys (KNHANES 2008-2011). Hepatology 2016; 63:776-86. [PMID: 26638128 DOI: 10.1002/hep.28376] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Sarcopenia is associated with nonalcoholic fatty liver disease (NAFLD). This study investigated whether sarcopenia is associated with significant liver fibrosis in subjects with NAFLD. Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 database were analyzed. NALFD was defined by NAFLD liver fat score, comprehensive NAFLD score, or hepatic steatosis index. Degree of liver fibrosis was assessed by NAFLD fibrosis score (NFS), FIB-4, and Forns index. Significant liver fibrosis was defined as FIB-4 ≥2.67 and the highest quartile values of NFS and Forns index. Sarcopenia index (= total appendicular skeletal muscle mass [kg]/body mass index (kg/m(2) ]) was calculated using dual-energy X-ray absorptiometry. Using the NAFLD liver fat score, NAFLD was identified in 2761 (28.5%) of 9676 subjects. Of subjects with NAFLD, sarcopenia was identified in 337 (12.2%). Sarcopenia was significantly associated with significant liver fibrosis assessed in fibrosis prediction models (all P < 0.05). In subgroups stratified according to body mass index and homeostasis model assessment of insulin resistance, a significant association between sarcopenia and significant liver fibrosis by NFS was consistently present (odds ratio = 1.76-2.68 depending on the subgroup, all P < 0.05). Multivariate logistic regression analysis demonstrated an independent association between SI and significant liver fibrosis by NFS after adjusting for other confounders (odds ratio = 0.52-0.67, all P < 0.01). Other NAFLD (comprehensive NAFLD score, hepatic steatosis index) and fibrosis prediction models (FIB-4 and Forns index) produced similar results. CONCLUSION Sarcopenia is associated with significant liver fibrosis in subjects with NAFLD, and the association is independent of obesity and insulin resistance.
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Affiliation(s)
- Yong-ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Kijun Song
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
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19
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Berzigotti A, Saran U, Dufour JF. Physical activity and liver diseases. Hepatology 2016; 63:1026-40. [PMID: 26313307 DOI: 10.1002/hep.28132] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/20/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED Regular physical activity beneficially impacts the risk of onset and progression of several chronic diseases. However, research regarding the effects of exercising on chronic liver diseases is relatively recent. Most researchers focused on nonalcoholic fatty liver disease (NAFLD), in which increasing clinical and experimental data indicate that skeletal muscle crosstalking to the adipose tissue and the liver regulates intrahepatic fat storage. In this setting, physical activity is considered to be required in combination with calories restriction to allow an effective decrease of intrahepatic lipid component, and despite that evidence is not conclusive, some studies suggest that vigorous activity might be more beneficial than moderate activity to improve NAFLD/nonalcoholic steatohepatitis. Evidence regarding the effects of exercise on the risk of hepatocellular carcinoma is scarce; some epidemiological studies indicate a lower risk in patients regularly and vigorously exercising. In compensated cirrhosis, exercise acutely increases portal pressure, but in the longer term it has been proved safe and probably beneficial. Decreased aerobic capacity (VO2 ) correlates with mortality in patients with decompensated cirrhosis, who are almost invariably sarcopenic. In these patients, VO2 is improved by physical activity, which might also reduce the risk of hepatic encephalopathy through an increase in skeletal muscle mass. In solid organ transplantation recipients, exercise is able to improve lean mass, muscle strength, and, as a consequence, aerobic capacity. Few data exist in liver transplant recipients, in whom exercise should be an object of future studies given its high potential of providing long-term beneficial effects. CONCLUSIONS Despite that evidence is far from complete, physical activity should be seen as an important part of the management of patients with liver disease in order to improve their clinical outcome.
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Affiliation(s)
- Annalisa Berzigotti
- Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital Berne, Berne, Switzerland
| | - Uttara Saran
- Hepatology, Department of Clinical Research, University of Berne, Berne, Switzerland
| | - Jean-François Dufour
- Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital Berne, Berne, Switzerland.,Hepatology, Department of Clinical Research, University of Berne, Berne, Switzerland
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Omoto M, Matsuse H, Hashida R, Takano Y, Yamada S, Ohshima H, Tagawa Y, Shiba N. Cycling Exercise with Electrical Stimulation of Antagonist Muscles Increases Plasma Growth Hormone and IL-6. TOHOKU J EXP MED 2015; 237:209-17. [PMID: 26522057 DOI: 10.1620/tjem.237.209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Performing aerobics and resistance exercise at exactly the same time has not been available although combining both types of exercise in one training program has been attempted. The hybrid training system (HTS) is a resistance exercise that combines voluntary concentric muscle contractions with electrically stimulated eccentric muscle contractions. We devised an exercise technique using HTS on a cycle ergometer (HCE). Growth hormone (GH) and lactate are indicators of adequate training intensity. Interleukin-6 (IL-6) reflects enhancing lipid metabolism. The purpose of this study was to show that HCE provides sufficient exercise to stimulate the secretion of GH, lactate and IL-6. We compared an HCE test with cycle ergometer alone (CE). Ten healthy male subjects performed HCE and CE tests for 30 minutes each. The workload of both tests was set the same at 40% of each subject's peak oxygen uptake. For HCE, 2-minute HTS and 1-minute rest intervals were repeated. GH, lactate, and IL-6 were evaluated before and immediately after exercise, and at 15, 30 and 60 minutes. GH and lactate increased immediately after HCE. Moreover, the degree of the increases in GH after HCE (0 and 15 minutes) was higher than that after CE. IL-6 increased after HCE at 30 min, and the rate of change was higher than for CE. These results showed that HCE was more efficient in stimulating acute increases in GH, lactate and IL-6 than CE at the same workload. We may be able to combine electrically stimulated resistance exercise with aerobic exercise using HCE.
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Shiba N, Matsuse H, Takano Y, Yoshimitsu K, Omoto M, Hashida R, Tagawa Y, Inada T, Yamada S, Ohshima H. Electrically Stimulated Antagonist Muscle Contraction Increased Muscle Mass and Bone Mineral Density of One Astronaut - Initial Verification on the International Space Station. PLoS One 2015; 10:e0134736. [PMID: 26296204 PMCID: PMC4546678 DOI: 10.1371/journal.pone.0134736] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/02/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Musculoskeletal atrophy is one of the major problems of extended periods of exposure to weightlessness such as on the International Space Station (ISS). We developed the Hybrid Training System (HTS) to maintain an astronaut's musculoskeletal system using an electrically stimulated antagonist to resist the volitional contraction of the agonist instead of gravity. The present study assessed the system's orbital operation capability and utility, as well as its preventative effect on an astronaut's musculoskeletal atrophy. METHODS HTS was attached to the non-dominant arm of an astronaut staying on the ISS, and his dominant arm without HTS was established as the control (CTR). 10 sets of 10 reciprocal elbow curls were one training session, and 12 total sessions of training (3 times per week for 4 weeks) were performed. Pre and post flight ground based evaluations were performed by Biodex (muscle performance), MRI (muscle volume), and DXA (BMD, lean [muscle] mass, fat mass). Pre and post training inflight evaluations were performed by a hand held dynamometer (muscle force) and a measuring tape (upper arm circumference). RESULTS The experiment was completed on schedule, and HTS functioned well without problems. Isokinetic elbow extension torque (Nm) changed -19.4% in HTS, and -21.7% in CTR. Isokinetic elbow flexion torque changed -23.7% in HTS, and there was no change in CTR. Total Work (Joule) of elbow extension changed -8.3% in HTS, and +0.3% in CTR. For elbow flexion it changed -23.3% in HTS and -32.6% in CTR. Average Power (Watts) of elbow extension changed +22.1% in HTS and -8.0% in CTR. For elbow flexion it changed -6.5% in HTS and -4.8% in CTR. Triceps muscle volume according to MRI changed +11.7% and that of biceps was +2.1% using HTS, however -0.1% and -0.4% respectively for CTR. BMD changed +4.6% in the HTS arm and -1.2% for CTR. Lean (muscle) mass of the arm changed only +10.6% in HTS. Fat mass changed -12.6% in HTS and -6.4% in CTR. CONCLUSIONS These results showed the orbital operation capability and utility, and the preventive effect of HTS for an astronaut's musculoskeletal atrophy. The initial flight data together with the ground data obtained so far will be utilized in the future planning of human space exploration.
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Affiliation(s)
- Naoto Shiba
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Rehabilitation, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- * E-mail:
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yoshio Takano
- Division of Physical Therapy, Fukuoka International University of Health and Welfare, Okawa city, Fukuoka 8318501, Japan
| | - Kazuhiro Yoshimitsu
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masayuki Omoto
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Rehabilitation, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ryuki Hashida
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Rehabilitation, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yoshihiko Tagawa
- Department of Mechanical and Control Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka, Japan
| | - Tomohisa Inada
- Department of Mechanical and Control Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka, Japan
| | - Shin Yamada
- Space Environment Utilization Center, Japan Aerospace Exploration Agency, Tsukuba, Ibaraki, Japan
| | - Hiroshi Ohshima
- Space Environment Utilization Center, Japan Aerospace Exploration Agency, Tsukuba, Ibaraki, Japan
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Whitsett M, VanWagner LB. Physical activity as a treatment of non-alcoholic fatty liver disease: A systematic review. World J Hepatol 2015; 7:2041-52. [PMID: 26261693 PMCID: PMC4528277 DOI: 10.4254/wjh.v7.i16.2041] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/08/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To review the effectiveness of exercise as a therapy for nonalcoholic fatty liver disease (NAFLD) and potential benefits in treating insulin resistance and atherosclerosis. METHODS Medline (EBSCOhost) and PubMed were searched for English-language randomized controlled trials and prospective cohort studies in human adults aged ≥ 18 which investigated the various effects of exercise alone, a combination of exercise and diet, or exercise and diet coupled with behavioral modification on NAFLD from 2010 to Feburary 2015. RESULTS Eighteen of 2298 available studies were chosen for critical review, which included 6925 patients. Nine (50%) studies were randomized controlled trials. Five (27.8%) studies utilized biopsy to examine the effects of physical activity on hepatic histology. The most commonly employed imaging modality to determine change in hepatic steatosis was hydrogen-magnetic resonance spectroscopy. Only two studies examined the effects of low impact physical activity for patients with significant mobility limitations and one compared the efficacy of aerobic and resistance exercise. No studies examined the exact duration of exercise required for hepatic and metabolic improvement in NAFLD. CONCLUSION While exercise improved hepatic steatosis and underlying metabolic abnormalities in NAFLD, more studies are needed to define the most beneficial form and duration of exercise treatment.
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Affiliation(s)
- Maureen Whitsett
- Maureen Whitsett, Lisa B VanWagner, Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Lisa B VanWagner
- Maureen Whitsett, Lisa B VanWagner, Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
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Joubert M, Metayer L, Prevost G, Morera J, Rod A, Cailleux A, Parienti JJ, Reznik Y. Neuromuscular electrostimulation and insulin sensitivity in patients with type 2 diabetes: the ELECTRODIAB pilot study. Acta Diabetol 2015; 52:285-91. [PMID: 25107502 DOI: 10.1007/s00592-014-0636-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/23/2014] [Indexed: 01/31/2023]
Abstract
AIM Physical activity (PA) improves insulin sensitivity and is particularly important for type 2 diabetes (T2D) management; however, patient adherence is poor. Neuromuscular electrostimulation (NMES) is widely used for rehabilitation issues, but the metabolic impact of provoked involuntary muscular contractions has never been investigated. MATERIALS AND METHODS ELECTRODIAB is a prospective, bi-centric, and 4-week-long pilot study that enrolled 18 patients with T2D who did not require insulin treatment. Insulin sensitivity was evaluated by euglycemic hyperinsulinemic clamp before and after (1) a single NMES session and (2) a week of daily NMES training. Energy expenditure (EE) at baseline and during NMES was evaluated by indirect calorimetry. Dietary and background PA were monitored to avoid bias. RESULTS After a single session (T1) or a week (T2) of NMES training, insulin sensitivity (M value) increased by 9.3 ± 38.2 % (ns) and 24.9 ± 35.8 % (p = 0.009), respectively, compared with the baseline (T0). Insulin sensitivity increased up to 46.2 ± 33.8 % (p = 0.002) at T2 in the more insulin-resistant subjects (baseline M value ≤4 mg/Kg/min, n = 10). The NMES session-generated EE was 1.42 ± 9.27 kcal/h, which was not significantly increased from the baseline. CONCLUSIONS Insulin sensitivity was significantly improved in patients with T2D after 1 week of daily NMES training, with very low EE. NMES could be an alternative to conventional PA, but the putative mechanisms of action must still be investigated.
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Affiliation(s)
- Michael Joubert
- Diabetes Care Unit, University Hospital of Caen, Caen, France,
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24
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Oh S, Maruyama T, Eguchi K, Shida T, Arai E, Isobe T, Okamoto Y, Shoda J. Therapeutic effect of hybrid training of voluntary and electrical muscle contractions in middle-aged obese women with nonalcoholic fatty liver disease: a pilot trial. Ther Clin Risk Manag 2015; 11:371-80. [PMID: 25767392 PMCID: PMC4354454 DOI: 10.2147/tcrm.s75109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Exercise training is an effective therapy for nonalcoholic fatty liver disease (NAFLD). Hybrid training (HYB) of voluntary and electrical muscle contractions was developed to prevent disuse atrophy during space flight. HYB can be applied to obtain a strength training effect accompanying articular movement. In this pilot study, we aimed to investigate the therapeutic efficacy of HYB in NAFLD. Methods A total of 15 middle-aged obese women with NAFLD who had no improvement in serum alanine aminotransferase levels and/or liver fat deposition after 12 weeks of lifestyle counseling participated in an HYB program. HYB of the quadriceps and hamstrings was conducted for 20 minutes twice a week for 24 weeks. Results NAFLD patients showed attenuated intramyocellular lipid levels in the quadriceps after the HYB intervention (−15.5%). Levels of leptin (−17.4%), tumor necrosis factor-α (−23.2%), and interleukin-6 (−30.5%) were also decreased after the intervention. HYB led to a significant body weight reduction (−4.7%), which in turn was associated with a significant decrease in serum alanine aminotransferase (−35.8%), gamma-glutamyl transpeptidase (−21.6%), ferritin (−16.0%), oxidative stress (−17.8%) levels, and insulin resistance values (−2.7%). Conclusion In NAFLD, HYB exerts an antiobesity effect and attenuates liver dysfunction and insulin resistance in association with an increase in muscle strength and a decrease in ectopic muscle fat. Therefore, HYB has great potential as a new type of exercise therapy for liver disease in patients with NAFLD.
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Affiliation(s)
- Sechang Oh
- Division of Medical Science, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan ; Japan Society for the Promotion of Science, Tokyo, Japan
| | - Tsuyoshi Maruyama
- Division of Rehabilitation, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Kiyoshi Eguchi
- Division of Rehabilitation, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Takashi Shida
- Division of Medical Science, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Emi Arai
- Division of Medical Science, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomonori Isobe
- Division of Medical Science, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshikazu Okamoto
- Division of Diagnostic Radiology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Junichi Shoda
- Division of Medical Science, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Chen L, Chen R, Wang H, Liang F. Mechanisms Linking Inflammation to Insulin Resistance. Int J Endocrinol 2015; 2015:508409. [PMID: 26136779 PMCID: PMC4468292 DOI: 10.1155/2015/508409] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/04/2015] [Indexed: 12/14/2022] Open
Abstract
Obesity is now widespread around the world. Obesity-associated chronic low-grade inflammation is responsible for the decrease of insulin sensitivity, which makes obesity a major risk factor for insulin resistance and related diseases such as type 2 diabetes mellitus and metabolic syndromes. The state of low-grade inflammation is caused by overnutrition which leads to lipid accumulation in adipocytes. Obesity might increase the expression of some inflammatory cytokines and activate several signaling pathways, both of which are involved in the pathogenesis of insulin resistance by interfering with insulin signaling and action. It has been suggested that specific factors and signaling pathways are often correlated with each other; therefore, both of the fluctuation of cytokines and the status of relevant signaling pathways should be considered during studies analyzing inflammation-related insulin resistance. In this paper, we discuss how these factors and signaling pathways contribute to insulin resistance and the therapeutic promise targeting inflammation in insulin resistance based on the latest experimental studies.
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Affiliation(s)
- Li Chen
- Hubei University of Chinese Medicine, Wuhan 430061, China
- Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan 430061, China
| | - Rui Chen
- Integrated TCM and Western Medicine Department, Union Hospital, Tongji Medical College of Huazhong Science and Technology University, Wuhan 430022, China
| | - Hua Wang
- Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan 430061, China
- Acupuncture and Moxibustion College, Hubei University of Chinese Medicine, Wuhan 430061, China
| | - Fengxia Liang
- Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan 430061, China
- Acupuncture and Moxibustion College, Hubei University of Chinese Medicine, Wuhan 430061, China
- *Fengxia Liang:
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26
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Effects of physical activity upon the liver. Eur J Appl Physiol 2014; 115:1-46. [DOI: 10.1007/s00421-014-3031-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 10/14/2014] [Indexed: 02/07/2023]
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27
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AMANO KEISUKE, KAWAGUCHI TAKUMI, KUROMATSU RYOKO, KAWAGUCHI ATSUSHI, MIYAJIMA ICHIRO, IDE TATSUYA, KAKUMA TATSUYUKI, SATA MICHIO. Time trends of clinical characteristics in hepatocellular carcinoma patients with chronic hepatitis B virus infection: A field survey between 2000 and 2012. Mol Clin Oncol 2014; 2:927-934. [PMID: 25279176 PMCID: PMC4179821 DOI: 10.3892/mco.2014.398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/12/2014] [Indexed: 12/14/2022] Open
Abstract
The hepatitis B virus (HBV) carrier rate has decreased in Japan; however, the incidence of HBV infection among hepatocellular carcinoma (HCC) patients has not decreased accordingly. In this study, we aimed to assess the time trends of the clinical characteristics in HCC patients with chronic HBV infection. Between 2000 and 2012, we enrolled a total of 156 HCC patients with chronic HBV infection in our field survey. The HCC risk was evaluated using the HCC prediction score, which is constructed from the characteristics of age, presence of liver cirrhosis and serum levels of albumin, bilirubin and HBV DNA. Lifestyle factors and the presence of diabetes mellitus were also evaluated. The time trends of patient characteristics were analyzed using the Jonckheere-Terpstra proportion trend test. Among HCC patients with chronic HBV infection, the proportion of patients at high risk according to the HCC prediction score significantly decreased during the study period (P=0.0005). Similarly, the proportion of patients with liver cirrhosis, ≤3.5 g/dl serum albumin level, >4 log copies/ml serum HBV DNA level and ≥60 g/day alcohol intake were also significantly decreased. The proportion of male and obese patients was not significantly altered, whereas the proportion of elderly (≥65 years) and diabetic patients tended to increase during the study period (P=0.0654 and P=0.0528, respectively). In this study, we analyzed the time trends of the clinical characteristics in HCC patients with chronic HBV infection and demonstrated that aging and diabetes mellitus may be involved in the hepatocarcinogenesis in patients with chronic HBV infection.
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Affiliation(s)
- KEISUKE AMANO
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
- Consulting and Support Center for Liver Disease, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
| | - TAKUMI KAWAGUCHI
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
- Department of Digestive Disease Information and Research, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - RYOKO KUROMATSU
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - ATSUSHI KAWAGUCHI
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto 606-8501, Japan
| | - ICHIRO MIYAJIMA
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
- Consulting and Support Center for Liver Disease, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
| | - TATSUYA IDE
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
- Consulting and Support Center for Liver Disease, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
| | - TATSUYUKI KAKUMA
- Biostatistics Center, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - MICHIO SATA
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
- Consulting and Support Center for Liver Disease, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
- Department of Digestive Disease Information and Research, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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28
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Yamada S, Kawaguchi A, Kawaguchi T, Fukushima N, Kuromatsu R, Sumie S, Takata A, Nakano M, Satani M, Tonan T, Fujimoto K, Shima H, Kakuma T, Torimura T, Charlton MR, Sata M. Serum albumin level is a notable profiling factor for non-B, non-C hepatitis virus-related hepatocellular carcinoma: A data-mining analysis. Hepatol Res 2014; 44:837-45. [PMID: 23819517 DOI: 10.1111/hepr.12192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 12/12/2022]
Abstract
AIM Various factors are underlying for the onset of non-B, non-C hepatitis virus-related hepatocellular carcinoma (NBNC-HCC). We aimed to investigate the independent risk factors and profiles associated with NBNC-HCC using a data-mining technique. METHODS We conducted a case-control study and enrolled 223 NBNC-HCC patients and 669 controls from a health checkup database (n = 176 886). Multivariate analysis, random forest analysis and a decision-tree algorithm were employed to examine the independent risk factors, factors distinguishing between the case and control groups, and to identify profiles for the incidence of NBNC-HCC, respectively. RESULTS In multivariate analysis, besides γ-glutamyltransferase (GGT) levels and the Brinkman index, albumin level was an independent negative risk factor for the incidence of NBNC-HCC (odds ratio = 0.67; 95% confidence interval = 0.60-0.70; P < 0.0001). In random forest analysis, serum albumin level was the highest-ranked variable for distinguishing between the case and control groups (98 variable importance). A decision-tree algorithm was created for albumin and GGT levels, the aspartate aminotransferase-to-platelet ratio index (APRI) and the Brinkman index. The serum albumin level was selected as the initial split variable, and 82.5% of the subjects with albumin levels of less than 4.01 g/dL were found to have NBNC-HCC. CONCLUSION Data-mining analysis revealed that serum albumin level is an independent risk factor and the most distinguishable factor associated with the incidence of NBNC-HCC. Furthermore, we created an NBNC-HCC profile consisting of albumin and GGT levels, the APRI and the Brinkman index. This profile could be used in the screening strategy for NBNC-HCC.
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Affiliation(s)
- Shingo Yamada
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Japan
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Okamoto Y, Kemp GJ, Isobe T, Sato E, Hirano Y, Shoda J, Minami M. Changes in diffusion tensor imaging (DTI) eigenvalues of skeletal muscle due to hybrid exercise training. Magn Reson Imaging 2014; 32:1297-300. [PMID: 25086331 DOI: 10.1016/j.mri.2014.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 03/29/2014] [Accepted: 07/24/2014] [Indexed: 10/25/2022]
Abstract
Several studies have proposed the cell membrane as the main water diffusion restricting factor in the skeletal muscle cell. We sought to establish whether a particular form of exercise training (which is likely to affect only intracellular components) could affect water diffusion. The purpose of this study is to characterise prospectively the changes in diffusion tensor imaging (DTI) eigenvalues of thigh muscle resulting from hybrid training (HYBT) in patients with non-alcoholic fatty liver disease (NAFLD). Twenty-one NAFLD patients underwent HYBT for 30 minutes per day, twice a week for 6 months. Patients were scanned using DTI of the thigh pre- and post-HYBT. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), the three eigenvalues lambda 1 (λ1), λ2, λ3, and the maximal cross sectional area (CSA) were measured in bilateral thigh muscles: knee flexors (biceps femoris (BF), semitendinosus (ST), semimembranous (SM)) and knee extensors (medial vastus (MV), intermediate vastus (IV), lateral vastus (LV), and rectus femoris (RF)), and compared pre- and post-HYBT by paired t-test. Muscle strength of extensors (P<0.01), but not flexors, increased significantly post-HYBT. For FA, ADC and eigenvalues, the overall picture was of increase. Some (P<0.05 in λ2 and P<0.01 in λ1) eigenvalues of flexors and all (λ1-λ3) eigenvalues of extensors increased significantly (P<0.01) post-HYBT. HYBT increased all 3 eigenvalues. We suggest this might be caused by enlargement of muscle intracellular space.
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Affiliation(s)
- Yoshikazu Okamoto
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba Hospital, Ibaraki, Japan.
| | - Graham J Kemp
- Department of Musculoskeletal Biology, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Tomonori Isobe
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Eisuke Sato
- Department of Radiology, University of Kitasato, Tokyo, Japan
| | - Yuji Hirano
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Junichi Shoda
- Department of Gastroenterology, Institute of Clinical Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Manabu Minami
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba Hospital, Ibaraki, Japan
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30
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Croymans DM, Paparisto E, Lee MM, Brandt N, Le BK, Lohan D, Lee CC, Roberts CK. Resistance training improves indices of muscle insulin sensitivity and β-cell function in overweight/obese, sedentary young men. J Appl Physiol (1985) 2013; 115:1245-53. [PMID: 23970530 PMCID: PMC3841835 DOI: 10.1152/japplphysiol.00485.2013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/18/2013] [Indexed: 12/30/2022] Open
Abstract
We examined the effects of RT on oral glucose tolerance test (OGTT)-derived indices of muscle insulin sensitivity, hepatic insulin resistance, β-cell function, and skeletal muscle proteins related to glucose transport in overweight/obese, sedentary young men. Twenty-eight participants [median body mass index (BMI) 30.9 kg/m(2); age 22 yr] completed 12 wk of RT (3 sessions/wk) and were assessed for changes in OGTT-derived indices, resting metabolic rate, body composition, serum adipokines, and skeletal muscle protein content [hexokinase 2 (HK2), glucose transporter type 4 (GLUT4), RAC-β serine/threonine-protein kinase (AKT2), glycogen synthase kinase 3β, and insulin receptor substrate 1]. Individualized responses to RT were also evaluated. RT significantly improved insulin and glucose area under the curve (both P < 0.03). With the use of OGTT indices of insulin action, we noted improved muscle insulin sensitivity index (mISI; P = 0.03) and oral disposition index (P = 0.03). BMI, lean body mass (LBM), and relative strength also increased (all P < 0.03), as did skeletal muscle protein content of HK2, GLUT4, and AKT2 (26-33%; all P < 0.02). Hepatic insulin resistance index, adiponectin, leptin, and total amylin did not change. Further analysis demonstrated the presence of highly individualized responsiveness to RT for glucose tolerance and other outcomes. RT improved oral indices of muscle insulin sensitivity and β-cell function but not hepatic insulin resistance in overweight/obese young men. In addition to the increase in LBM, the improvements in insulin action may be due, in part, to increases in key insulin signaling proteins.
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Affiliation(s)
- Daniel M Croymans
- David Geffen School of Medicine, University of California, Los Angeles, California
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Williams KH, Shackel NA, Gorrell MD, McLennan SV, Twigg SM. Diabetes and nonalcoholic Fatty liver disease: a pathogenic duo. Endocr Rev 2013; 34:84-129. [PMID: 23238855 DOI: 10.1210/er.2012-1009] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent data increasingly support a complex interplay between the metabolic condition diabetes mellitus and the pathologically defined nonalcoholic fatty liver disease (NAFLD). NAFLD predicts the development of type 2 diabetes and vice versa, and each condition may serve as a progression factor for the other. Although the association of diabetes and NAFLD is likely to be partly the result of a "common soil," it is also probable that diabetes interacts with NAFLD through specific pathogenic mechanisms. In particular, through interrelated metabolic pathways currently only partly understood, diabetes appears to accelerate the progression of NAFLD to nonalcoholic steatohepatitis, defined by the presence of necroinflammation, with varying degrees of liver fibrosis. In the research setting, obstacles that have made the identification of clinically significant NAFLD, and particularly nonalcoholic steatohepatitis, difficult are being addressed with the use of new imaging techniques combined with risk algorithms derived from peripheral blood profiling. These techniques are likely to be used in the diabetes population in the near future. This review examines the pathogenic links between NAFLD and diabetes by exploring the epidemiological evidence in humans and also through newer animal models. Emerging technology to help screen noninvasively for differing pathological forms of NAFLD and the potential role of preventive and therapeutic approaches for NAFLD in the setting of diabetes are also examined.
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Affiliation(s)
- K H Williams
- Sydney Medical School and the Bosch Institute, The University of Sydney, Sydney, New South Wales 2006, Australia
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Finelli C, Tarantino G. Have guidelines addressing physical activity been established in nonalcoholic fatty liver disease? World J Gastroenterol 2012; 18:6790-800. [PMID: 23239917 PMCID: PMC3520168 DOI: 10.3748/wjg.v18.i46.6790] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/29/2012] [Accepted: 07/09/2012] [Indexed: 02/06/2023] Open
Abstract
The purpose of this review was to highlight, in relation to the currently accepted pathophysiology of non-alcoholic fatty liver disease (NAFLD), the known exercise habits of patients with NAFLD and to detail the benefits of lifestyle modification with exercise (and/or physical activity) on parameters of metabolic syndrome. More rigorous, controlled studies of longer duration and defined histopathological end-points comparing exercise alone and other treatment are needed before better, evidence-based physical activity modification guidelines can be established, since several questions remain unanswered.
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Rodriguez B, Torres DM, Harrison SA. Physical activity: an essential component of lifestyle modification in NAFLD. Nat Rev Gastroenterol Hepatol 2012; 9:726-31. [PMID: 23090329 DOI: 10.1038/nrgastro.2012.200] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
NAFLD encompasses a spectrum of liver diseases pertaining to fat accumulation in the liver in the absence of significant alcohol consumption. NASH is the most clinically relevant subset of NAFLD, and patients with NASH have an increased risk of progression to cirrhosis or developing liver cancer. No pharmacotherapy is currently approved for NAFLD, and lifestyle modification via diet and exercise is most commonly recommended. The optimal physical activity regimen in terms of both effectiveness and compliance remains to be determined and is the focus of this Review.
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Affiliation(s)
- Benjamin Rodriguez
- Division of Gastroenterology, Department of Medicine, Walter Reed National Military Medical Center, Washington, DC 20889, USA
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Otsuka M, Uchida Y, Kawaguchi T, Taniguchi E, Kawaguchi A, Kitani S, Itou M, Oriishi T, Kakuma T, Tanaka S, Yagi M, Sata M. Fish to meat intake ratio and cooking oils are associated with hepatitis C virus carriers with persistently normal alanine aminotransferase levels. Hepatol Res 2012; 42:982-9. [PMID: 22536921 DOI: 10.1111/j.1872-034x.2012.01014.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Dietary habits are involved in the development of chronic inflammation; however, the impact of dietary profiles of hepatitis C virus carriers with persistently normal alanine transaminase levels (HCV-PNALT) remains unclear. The decision-tree algorithm is a data-mining statistical technique, which uncovers meaningful profiles of factors from a data collection. We aimed to investigate dietary profiles associated with HCV-PNALT using a decision-tree algorithm. METHODS Twenty-seven HCV-PNALT and 41 patients with chronic hepatitis C were enrolled in this study. Dietary habit was assessed using a validated semiquantitative food frequency questionnaire. A decision-tree algorithm was created by dietary variables, and was evaluated by area under the receiver operating characteristic curve analysis (AUROC). RESULTS In multivariate analysis, fish to meat ratio, dairy product and cooking oils were identified as independent variables associated with HCV-PNALT. The decision-tree algorithm was created with two variables: a fish to meat ratio and cooking oils/ideal bodyweight. When subjects showed a fish to meat ratio of 1.24 or more, 68.8% of the subjects were HCV-PNALT. On the other hand, 11.5% of the subjects were HCV-PNALT when subjects showed a fish to meat ratio of less than 1.24 and cooking oil/ideal bodyweight of less than 0.23 g/kg. The difference in the proportion of HCV-PNALT between these groups are significant (odds ratio 16.87, 95% CI 3.40-83.67, P = 0.0005). Fivefold cross-validation of the decision-tree algorithm showed an AUROC of 0.6947 (95% CI 0.5656-0.8238, P = 0.0067). CONCLUSION The decision-tree algorithm disclosed that fish to meat ratio and cooking oil/ideal bodyweight were associated with HCV-PNALT.
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Affiliation(s)
- Momoka Otsuka
- Departments of Clinical Nutrition Nutrition, Kurume University HospitalDepartments of Digestive Disease Information & Research Medicine Pediatric Surgery, Kurume University School of Medicine Biostatistics Center, Kurume University Department of Biostatistics, Kurume University Graduate School of Medicine, Kurume, Japan
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Itou M, Kawaguchi T, Taniguchi E, Oriishi T, Sata M. Dipeptidyl Peptidase IV Inhibitor Improves Insulin Resistance and Steatosis in a Refractory Nonalcoholic Fatty Liver Disease Patient: A Case Report. Case Rep Gastroenterol 2012; 6:538-44. [PMID: 22949894 PMCID: PMC3432996 DOI: 10.1159/000341510] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A 67-year-old Asian woman was referred to Kurume University Hospital due to abnormal liver function tests. She was diagnosed with nonalcoholic fatty liver disease (NAFLD). NAFLD was treated by diet therapy with medication of metformin and pioglitazone; however, NAFLD did not improve. Subsequently, the patient was administered sitagliptin. Although her energy intake and physical activity did not change, her hemoglobin A1c level was decreased from 7.8 to 6.4% 3 months after treatment. Moreover, her serum insulin level and homeostasis model assessment-insulin resistance value were also improved, as was the severity of hepatic steatosis. These findings indicate that sitagliptin may improve insulin resistance and steatosis in patients with refractory NAFLD.
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Affiliation(s)
- Minoru Itou
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
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The role of nutrients in the development, progression, and treatment of nonalcoholic fatty liver disease. J Clin Gastroenterol 2012; 46:457-67. [PMID: 22469640 DOI: 10.1097/mcg.0b013e31824cf51e] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in adults and children and is currently the third most common indication for liver transplantation in North America. Its pathogenesis is thought to be secondary to multiple "hits" derived from the dietary components, adipose tissue, immune system, and intestinal microbiota. Lack of physical activity may contribute as well. Nutrients may exert their effect directly or through alteration of the intestinal microbiota. Research focusing on specific dietary components predisposing to NAFLD has shown conflicting results. Total energy intake, and macronutrients, has been linked to the development of NAFLD. Fructose not only contributes to hepatic steatosis but may trigger inflammatory signals as well. Polyunsaturated fatty acids are thought to exert anti-inflammatory effects. The role of vitamins as well as minerals in this field is actively being investigated. In this review, we discuss the evidence-linking macronutrients (such as carbohydrates and fat in general and fructose, fiber, short chain fatty acids, polyunsaturated fatty, and choline specifically) and micronutrients (such as vitamin E and C and minerals) with the development and treatment of NAFLD. We also discuss the literature on physical activity and NAFLD.
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