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Effect of Long-Term Exercise on Liver Lipid Metabolism in Chinese Patients With NAFLD: A Systematic Review and Meta-Analysis.

ABSTRACT: Purpose: Using meta-analysis to evaluate the effect of various long-term exercises (more than 4 weeks) on liver lipid metabolism of Chinese patients with non-alcoholic fatty liver disease (NAFLD) and provides more targeted exercise recommendations. Methods: Four databases consisting of PubMed, Web of Science, China Science and Technology Journal Database (VIP), China Knowledge Resource Integrated Database (CNKI) were searched up to May 2021. Randomized controlled trials (RCTs) were eligible, and the outcomes of body composition, lipid metabolism [including triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C)], and liver function [including alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] were used to assess the effectiveness of long-term exercise on Chinese patients with NAFLD. Results: Eleven articles with a total of 13 data points (involving 1,006 participants) satisfied the inclusion criteria and were pooled in the meta-analysis. The findings demonstrated that long-term exercise decreased the level of TG [-0.50, 95%CI (-0.64, -0.36)], TC [-0.55, 95%CI (-0.92, -0.18)], LDL-C [-0.29, 95%CI (-0.43, -0.15)], ALT [-3.45, 95%CI (-6.78, -0.12)], AST [-6.91, 95%CI (-10.00, -3.81)], and body mass index (BMI) of patients who did exercise last more than 6 months [-1.55, 95%CI (-2.32, -0.79)] significantly. The effect on HDL-C was not obvious. Conclusion: Long-term exercise can improve the levels of TG, TC, LDL-C, ALT, and AST in Chinese patients with NAFLD significantly, and exercise last more than 6 months can decrease the BMI of Chinese patients with NAFLD.

SUBMITTER: Gao Y

PROVIDER: S-EPMC8646046 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background & aimsLong-term studies of the prognosis of NAFLD are scarce. Here, we investigated the risk of major adverse liver outcomes (MALO) in a large cohort of patients with NAFLD.MethodsWe conducted a cohort study with data from Swedish university hospitals. Patients (n = 1,260) with NAFLD without cirrhosis were diagnosed through biopsy or radiology, and had fibrosis estimated through vibration-controlled transient elastography, biopsy, or FIB-4 score between 1974 and 2020 and followed up through 2020. Each patient was matched on age, sex, and municipality with up to 10 reference individuals from the general population (n = 12,529). MALO were ascertained from Swedish national registers. The rate of events was estimated by Cox regression.ResultsMALO occurred in 111 (8.8%, incidence rate = 5.9/1,000 person-years) patients with NAFLD and 197 (1.6%, incidence rate = 1.0/1,000 person-years) reference individuals during a median follow up of 13 years. The rate of MALO was higher in patients with NAFLD (hazard ratio = 6.6; 95% CI = 5.2-8.5). The risk of MALO was highly associated with the stage of fibrosis at diagnosis. In the biopsy subcohort (72% of total sample), there was no difference in risk between patients with and without non-alcoholic steatohepatitis. The 20-year cumulative incidences of MALO were 2% for the reference population, 3% for patients with F0, and 35% for F3. Prognostic information from biopsy was comparable to FIB-4 (C-indices around 0.73 vs. 0.72 at 10 years).ConclusionsThis study provides updated information on the natural history of NAFLD, showing a high rate of progression to cirrhosis in F3 and a similar prognostic capacity of non-invasive tests to liver biopsy.Impact and implicationsSeveral implications for clinical care and future research may be noted based on these results. First, the risk estimates for cirrhosis development are important when communicating risk to patients and deciding on clinical monitoring and treatment. Estimates can also be used in updated health-economic evaluations, and for regulatory agencies. Second, our results again highlight the low predictive information obtained from ascertaining NASHstatus by histology and call for more objective means by which to define NASH. Such methods may include artificial intelligence-supported digital pathology. We highlight that NASH is most likely the causal factor for fibrosis progression in NAFLD, but the subjective definition makes the prognostic value of a histological NASH diagnosis of limited value. Third, the finding that prognostic information from biopsy and the very simple Fibrosis-4 score were comparable is important as it may lead to fewer biopsies and further move the field towards non-invasive means by which to define fibrosis and, importantly, use non-invasive tests as outcomes in clinical trials. However, all modalities had modest discriminatory capacity and new risk stratification systems are needed in NAFLD. Repeated measures of non-invasive scores may be a potential solution.

Project description:Background. Baduanjin exercise is considered to be beneficial to modulate the blood lipid metabolism. The purpose of the systematic review was to assess the potential efficacy and safety of Baduanjin exercise. Methods. MEDLINE, EMBASE, CBM, CNKI, VIP, Chinese Important Conference Papers Database, and Chinese Dissertation Database were searched for all prospective-controlled trials of Baduanjin exercise from their inception to December 31, 2011. Results. A total of 14 studies were included. Comparing with no treatment, Baduanjin exercise significantly reduced the levels of TC, TG, LDL-C in plasma, and elevated plasma HDL-C level for healthy participants, and the pooled MD (95% confidence interval, CI) was -0.58 mmol/L (-0.86, -0.30 mmol/L), -0.22 mmol/L (-0.31, -0.13 mmol/L), -0.35 mmol/L (-0.54, -0.17 mmol/L), 0.13 mmol/L (0.06, 0.21 mmol/L), respectively. Baduanjin exercise also obviously decreased the levels of TG, LDL-C in plasma comparing with no treatment for patients, and the pooled MD (95% CI) was -0.30 mmol/L (-0.40, -0.19 mmol/L), -0.38 mmol/L (-0.63, -0.13 mmol/L), but there was not obvious to decrease plasma TC level or elevate plasma HDL-C level in patients with the pooled MD (95%CI), -0.39 mmol/L (-1.09, 0.31 mmol/L) and 0.22 mmol/L (-0.11, 0.55 mmol/L), respectively. In addition, the obvious advantage was not observed to modulate the blood lipid metabolism in comparing Baduanjin exercise with other exercises, regardless for health participants or patients. Conclusion. Studies indicated that Baduanjin exercise could significantly decrease the levels of TC, TG, LDL-C levels in plasma and elevate plasma HDL-C level for the healthy people. It also was helpful that Baduanjin exercise modulated the blood lipid metabolism for patients. Moreover, the Baduanjin exercise did not have an obvious advantage on modulating the lipid metabolism comparing with other exercises. But the evidence was uncertain because of the small sample size and low-methodological quality.

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Effect of Long-Term Exercise on Liver Lipid Metabolism in Chinese Patients With NAFLD: A Systematic Review and Meta-Analysis.

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