Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Hepatol. Jul 27, 2012; 4(7): 209-217
Published online Jul 27, 2012. doi: 10.4254/wjh.v4.i7.209
Life style modification improves insulin resistance and liver histology in patients with non-alcoholic fatty liver disease
Ganesh Bhat, Chalamalasetty Sreenivasa Baba, Amaresh Pandey, Neeraj Kumari, Gourdas Choudhuri
Ganesh Bhat, Department of Gastroenterology, Kasturba Medical College, Manipal University, Manipal 576104, India
Chalamalasetty Sreenivasa Baba, Amaresh Pandey, Gourdas Choudhuri, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
Neeraj Kumari, Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
Author contributions: Bhat G, Baba CS, Choudhuri G contributed equally to this work, designed the research, analyzed data, and wrote the paper; Pandey A performed the research and analytic tools; Kumari N contributed to the Histopathology section.
Correspondence to: Dr. Gourdas Choudhuri, Professor, Head, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India. choudhuri.gour@gmail.com
Telephone: +91-522-2668017 Fax: +91-522-2668017
Received: February 1, 2012
Revised: June 30, 2012
Accepted: July 21, 2012
Published online: July 27, 2012
Abstract

AIM: To study the effect of regular aerobic exercise on insulin resistance, serum aminotransferase and liver histology in nonalcoholic fatty liver disease (NAFLD) patients.

METHODS: Sixty (mean age 40.0 ± 8.5 years, 75% male) NAFLD patients were included in the study. After baseline anthropometric measurement i.e., body mass index (BMI), waist circumference (WC); all patients were advised regular aerobic exercise for 30 min/d, for at least 5 d/wk and trained to achieve around 70% of his maximal heart rate. In addition, moderately energy restricted diet was advised to patients with high BMI (> 25 kg/m2). Monthly follow up was done by measuring BMI, WC, aspartate aminotransferase, and alanine aminotransferase (ALT). Insulin resistance was calculated using homeostasis model assessment (HOMA) of insulin resistance (HOMA-IR) model, at baseline and after 6 mo. Insulin resistance was arbitrarily considered altered when it was ≥ 2. Liver biopsy was done in a section of patients at baseline and after 6 mo.

RESULTS: Seventy percent (42/60) patients were overweight or obese; 95% (57/60) had central obesity (WC > 90 cm in men, > 80 cm in women). In the 45 exercise compliant patients insulin resistance decreased from 6.4 ± 6.1 to 1.3 ± 1.0, BMI from 26.7 ± 3.3 kg/m2 to 25.0 ± 3.3 kg/m2, WC from 95.7 ± 8.9 cm to 90.8 ± 7.3 cm and ALT from 84.8 ± 43.5 U/L to 41.3 ± 18.2 U/L (P < 0.01). In 15 exercise noncompliant patient’s insulin resistance, BMI, WC and ALT did not show significant change at 6 mo follow up. Six of 8 patients in compliant group on repeat liver biopsy showed significant change in steatosis and necroinflammation. Nonalcoholic steatohepatitis scores improved form 5.3 ± 1.5 to 3.35 ± 1.5. The decline in insulin resistance correlated with decline in ALT (P = 0.01, rs = 0.90) and liver histology (P = 0.03, rs = 0.73).

CONCLUSION: Life style modification improves insulin resistance resulting in improvement in ALT and liver histology in NAFLD patients.

Keywords: Lifestyle changes; Insulin resistance; Metabolic syndrome; Nonalcoholic steatohepatitis; Liver histology