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Physical activity protects against, reverses hepatic steatosis

Physical activity prevented or reversed the progression of hepatic steatosis among patients with nonalcoholic fatty liver disease, according to a recently published study. Researchers also observed a protective factor among patients without NAFLD.

“The protective role of [physical activity levels] was evident in subjects that remained physically active from baseline to follow-up as well as in subjects that were not physically active in the beginning, but became physically active at follow-up,” Aline Mendes Gerage, from the Federal University of Santa Catarina, Brazil, and colleagues wrote. “These results are important clinically and suggest that even a relatively moderate-term physical activity regimen of about 31 months imparts beneficial effects that are sufficient to impact the severity of [hepatic steatosis (HS)].”

To evaluate the impact of physical activity on the progression of hepatic steatosis, the researchers enrolled 5,860 adults into a longitudinal study, including 1,902 patients with NAFLD and hepatic steatosis and 3,985 controls without hepatic steatosis.

The researchers assessed physical activity levels through the short version of the International Physical Activity Questionnaire, which classifies physical activity as 150 minutes or more per week of exercise and inactivity as less than 150 minutes.

Compared with controls, patients with hepatic steatosis were more often men (94 vs. 70; P < .01), older (44.8 vs. 41.3 years; P < .01), weighed more (89.9 vs. 74.5 kg; P < .01), had higher BMI (28.9 vs. 24.8 kg/m²; P < .01), and were more likely to be inactive (67% vs. 57.2%; P < .01). Less than half of both patients with hepatic steatosis (42.8%) and controls (33%) were physically active at baseline (P < .001).

During 12 to 82 months of follow-up14.8% of controls developed hepatic steatosis and 49.9% remained or became physically active. Those that remained (OR = 0.71; 95% CI, 0.57-0.88) or became physically active (OR = 0.72; 95% CI, 0.56-0.93) were significantly less likely to develop hepatic steatosis compared with physically inactive controls. This association remained significant after adjusting for confounders for both those who remained (OR = 0.66; 95% CI, 0.51-0.83) and became physically active (OR = 0.62; 95% CI, 0.48-0.81).

In the patient cohort, 15.2% reverted their hepatic steatosis status and 43.3% remained or became physically active after follow-up. Hepatic steatosis was less likely to persist in the patients who remained (OR = 0.66; 95% CI, 0.48-0.91) or became physically active (OR = 0.63; 95% CI, 0.46-0.87) compared with those who remained physically inactive. After adjustment for sex, age, follow-up time and number of metabolic syndrome components, physical activity remained a significant factor in reversal of hepatic steatosis status for both those who remained (OR = 0.66; 95% CI, 0.47-0.92) or became active (OR = 0.64; 95% CI, 0.46-0.9). The statistical significance did not remain, however, when the researchers included change in BMI during follow-up.

“It is likely that a redistribution of the body composition, rather than solely absolute weight reduction may trigger beneficial hepatic adaptation,” the researchers concluded. “Our results support the recommendation of regular physical activity as a mainstream intervention for prevention and treatment of NAFLD.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.