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Exercise-induced improvements in liver fat and endothelial function are not sustained 12 months following cessation of exercise supervision in nonalcoholic fatty liver disease


Supervised exercise reduces liver fat and improves endothelial function, a surrogate of cardiovascular disease (CVD) risk, in nonalcoholic fatty liver disease (NAFLD). We hypothesised that after a 16-week supervised exercise program, patients would maintain longer-term improvements in cardiorespiratory fitness, liver fat and endothelial function. Ten NAFLD patients (5/5 males/females, age 51±13 years, body mass index 31±3 kg m−2 (mean±s.d.)) underwent a 16-week supervised moderate-intensity exercise intervention. Biochemical markers, cardiorespiratory fitness (VO2peak), subcutaneous, visceral and liver fat (measured by magnetic resonance imaging and spectroscopy respectively) and brachial artery flow-mediated dilation (FMD) were assessed at baseline, after 16 weeks of supervised training and 12 months after ending supervision. Despite no significant change in body weight, there were significant improvements in VO2peak (6.5 ml kg−1 min−1 (95% confidence interval 2.8, 10.1); P=0.003), FMD (2.9% (1.5, 4.2); P=0.001), liver transaminases (P<0.05) and liver fat (−10.1% (−20.6, 0.5); P=0.048) immediately after the 16-week supervised training. Nevertheless, 12 months after ending supervision, VO2peak (0.9 ml kg−1 min−1 (−3.3, 5.1); P=0.65), FMD (−0.07% (−2.3, 2.2); P=0.95), liver transaminases (P>0.05) and liver fat (1.4% (−13.0, 15.9); P=0.83) were not significantly different from baseline. At 12 months following cessation of supervision, exercise-mediated improvements in liver fat and other cardiometabolic variables had reversed with cardiorespiratory fitness at baseline levels. Maintenance of high cardiorespiratory fitness and stability of body weight are critical public health considerations for the treatment of NAFLD ( identifier: NCT01834300).

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We thank all patients for their participation in the study. This study was funded by the European Federation for the Study of Diabetes (EFSD).

Author contributions

GJK, PR, AMU, DJG, NTC, HJ and DJC: conception and design of research; CJAP, VSS, FS-M, HJ and DJC performed experiments; CJAP, VSS, GJK, FS-M, AMU, DJG, NTC, HJ and DJC analysed data; CJAP, VSS, GJK, PR, FS-M, AMU, DJG, NTC, HJ and DJC interpreted results of experiments; CJAP, VSS, PR, HJ and DJC prepared figures; CJAP, HJ and DJC drafted manuscript; CJAP, VS.S, GJK, PR, FS-M, AMU, DJG, NTC, HJ and DJC edited and revised manuscript; CJAP, VSS, GJK, PR, FS-M, AMU, DJG, NTC, HJ and DJC approved final version of the manuscript.

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Correspondence to D J Cuthbertson.

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Pugh, C., Sprung, V., Jones, H. et al. Exercise-induced improvements in liver fat and endothelial function are not sustained 12 months following cessation of exercise supervision in nonalcoholic fatty liver disease. Int J Obes 40, 1927–1930 (2016).

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