Trials evaluating combination of exercise and dietary intervention on NAFLD outcomes
| Author (year); country | Intervention | Age range; sample size (% male) | Study duration | Outcome measures | Changes to outcome measures postintervention |
|---|---|---|---|---|---|
| Chen (2008);32 Taiwan | Hypocaloric diet 1200–1500 kcal/day and 1 hour 2×/week on stationary cycle (diet and exercise group, DPE); or exercise only group (E) | 29–46; 54 (62%) | 10 weeks | Primary: Steatosis grade (ultrasound), AST, ALT Other: WT, BMI, WC, HC, TC, TG, HDL, LDL, GLC, INS, HOMA-IR, GGT, CVE, HR | ↓ steatosis* grade both groups ↓ AST* and ↓ ALT*, greatest in DPE ↓ WT* and ↓ BMI both groups*, greatest in DPE group (6.3% vs. 0.9% in E) |
| Kantartzis (2009);33 Germany | Dietary counselling consisting of 10 sessions with dietitian and asked to perform 3 hours moderate exercise/week (eg, walking, swimming) | 19–68; 170 (41%) | 9 months | Primary: IHTG (MRS), AST, ALT Other: BMI, WC, FM, SAT, VAT, GLC, INS, VO2 max | ↓ IHTG* 35.2%; 20 of 50 NAFLD cases were resolved at follow up ↓ AST*, and ↓ ALT* ↓ BMI*, and ↓ VAT*, |
| Promrat (2010);34 USA | 1000–1500 kcal/day (25% fat), moderate intensity exercise progressing to 200 min/week with weekly (first 6 months) then biweekly health education sessions; or basic education sessions (every 12 weeks) on healthy eating, physical activity and weight control | 34–59; 31 (59%) | 48 weeks | Primary: NAS (liver biopsy), AST, ALT Other: WT, BMI, TG, LDL, HDL, GLC, INS, HbA1C, HOMA | ↓ NAS*, greatest change seen in intensive intervention(−2.4 vs. −1.4 in control) ↓ AST§, ↓ ALT*, (greatest change seen in intensive intervention‡ See ↓ AST but no significant difference between the two treatment groups ↓ WT* (8.8% in intensive vs. 0.5%) and ↓ BMI* |
| Rodrigues-Hernandez (2011);35 Mexico | Low calorie (30 kcal/kg/day), low CHO (27% protein, 28% fat, 45% CHO) plus 5 hours exercise/week; or an isocaloric, low fat (21% fat, 25% protein, 54% CHO) with same exercise | 20–65; 59 (0%) | 6 months | Primary: AST, ALT Other: WT, BMI, FM, GLC, TC, TG | ↓ AST* and ↓ ALT* in both groups, but no difference between diets. ↓ WT* (5.7% low cal, 5.5% low fat) and ↓ BMI* |
| Al-Jiffri (2013);36 Saudi Arabia | 1200 calories/day (15% protein, 30–35% fat, 50–55% CHO) plus aerobic exercise 30 min 3x/week | 35–55 100 (100%) | 3 months | Primary: AST, ALT Other: BMI, GGT, HOMA-IR, ALP | ↓ AST* and ↓ ALT* in diet plus exercise group ↓ BMI* in AER group |
| Eckard (2013);37 USA | Low-fat diet (20% fat, 60% CHO, 20% protein) with moderate exercise (20–60 min 4–7 days/week); moderate-fat/low CHO diet (30% fat, 50% CHO, 20% protein) with moderate exercise; or moderate exercise only | 18–70; 41 (61%) | 6 months | Primary: NAS (liver biopsy), AST, ALT Other: WT, BMI, LDL, HDL, TG, ALP, INS, GLC | ↓ NAS* in both diet and exercise combination groups (−1.3 low fat, −1.2 low CHO) ↓ AST§ and ↓ ALT* in all groups No significant change in WT among groups |
| Wong (2013);38 Hong Kong | Weight loss diet supervised by dietitian weekly (4 months) then monthly (8 months) plus moderate-intensity aerobic exercise 30 min 3–5 days/week | 42–60; 154 (46%) | 1 year | Primary: IHTG (H-MRS), LS, AST, ALT Other: WT, BMI, WC, WHR, GLC, TC, HDL, LDL, TG | ↓ IHTG* 54%, 49 of 77 NAFLD cases resolved (<5% IHTG at 1 year) ↓ LS*, ↓ ALT* and ↓ AST§ ↓ WT* (7.9%) and ↓ BMI* |
| Aller (2014);39 Spain | Hypocaloric diet either high MUFA (M; 1342 kcal/day, 21% fat of which 67% MUFA); or high PUFA (P; 1459 kcal/day, 21% fat of which 55% PUFA); with aerobic exercise 60 min 3×/week | 32–66; 306 (28%) | 3 months | Primary: ALT, AST Secondary: WT, BMI, FM, WC, WHR, GLC, TC, LDL, HDL, TG, INS, HOMA, GGT | ↓ ALT* and ↓ AST* in both groups ↓ WT* (4.4% M, 4.7% P) and ↓ BMI* No differences between M and P diets |
*Statistically significant.
§No statistically significant difference.
ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index (kg/m2); CVE, cardiovascular endurance; FM, fat mass, GGT, gamma glutaryl transferase; GLC, glucose; HbA1c, glycosylated haemoglobin; HC, hip circumference; HDL, high-density lipoprotein; HOMA, Homeostasis Model Assessment; HOMA-IR, Homeostasis Model Assessment-Insulin Resistance Index; HR, heart rate; IHTG, intrahepatic triglyceride; INS, insulin; LDL, low-density lipoprotein; LS, liver stiffness; MUFA, monounsaturated fat; MRS, magnetic resonance spectroscopy; NAFLD, non-alcoholic fatty liver disease; NAS, NAFLD activity score; PUFA, polyunsaturated fat; SAT, subcutaneous adipose tissue; TC, total cholesterol; TG, triglyceride; VAT, visceral adipose tissue; VO2 max, peak oxygen consumption (mL/kg/min); WC, waist circumference; WHR, waist:hip ratio; WT, weight.