[Study on the correlation between type 2 diabetes mellitus combined with non-alcoholic steatohepatitis and aerobic exercise performance].

Objective: To study the correlation between patients with type 2 diabetes mellitus combined with nonalcoholic steatohepatitis in order to provide theoretical support for the treatment of NAFLD through aerobic exercise performance. Methods: 253 cases with T2DM combined with NAFLD were selected. 93 cases consented to undergo a liver biopsy. Among them, 74 cases with liver biopsy successfully passed the symptom-limited cardiopulmonary exercise test (CPET) and respiratory quotient (RQ)≥1.05. Patients were divided into two groups according to the NAFLD activity score (NAS) of the pathological biopsy: the non-NASH group (NAS < 4) and the NASH group (NAS≥4). The differences in general clinical and biochemical indicators and exercise parameters were compared between the two groups. The relevant factors that affect aerobic exercise performance in NAFLD patients were explored by correlation and regression analysis. Results: The peak oxygen uptake [VO2 @ peak, (17.82 ± 5.61) ml·kg(-1)·min(-1) and (23.14 ± 5.86) ml·kg(-1)·min(-1)] and anaerobic threshold [VO2 @ AT, (11.47 ± 3.12) ml·kg(-1)·min(-1) and (13.81 ± 3.53) ml·kg(-1)·min(-1)] were lower in the NASH group than those in the non-NASH group in T2DM patients, with P < 0.01, indicating a significant decrease in aerobic exercise performance in NASH patients compared to non-NASH patients. Correlation analysis showed that patients with T2DM combined with NAFLD VO2@peak was positively correlated with RQ, carbohydrate oxidation rate (%CHO), daily carbohydrate energy supply (CHO Kcal/d), high-density lipoprotein cholesterol (HDL-C), and maximal voluntary ventilation (MVV) (r 0.360, 0.334, 0.341, 0.255, 0.294, P < 0.05 or P < 0.01, respectively) and negatively correlated with NAS score, fat attenuation, liver stiffness, fat oxidation rate (%FAT), daily fat energy supply (FAT Kcal/d), aspartate aminotransferase (AST), alanine aminotransferase (ALT), body mass, and body mass index (BMI) (r -0.558, -0.411, -0.437, -0.340, -0.270, -0.288, -0.331, -0.295, -0.469, P < 0.05 or P < 0.01, respectively). VO2@AT were positively correlated with RQ, %CHO, total cholesterol (TC), and HDL-C (r 0.351, 0.247, 0.303, 0.380, P < 0.05 or P < 0.01, respectively), while it was negatively correlated with NAS score, fat attenuation, liver stiffness, %FAT, FAT (Kcal/d), ferritin (Fer), ALT, AST, body weight, and BMI (r -0.330, -0.384, -0.428, -0.270, -0.318, 0.320, -0.404, -0.416, -0.389, -0.520, P < 0.05 or P < 0.01, respectively). Stepwise multiple regression analyses revealed that BMI, RQ, and NAS scores were independent correlated factors of aerobic exercise performance. Conclusion: Hepatic inflammation and fibrosis affect the aerobic exercise performance of patients with T2DM combined with NAFLD.

[Effect of aerobic exercise and resistance exercise in improving non-alcoholic fatty liver disease: a randomized controlled trial].

Objective: To investigate the effect of dietary control combined with different exercise modes on plasma vaspin, irisin, and metabolic parameters in patients with non-alcoholic fatty liver disease (NAFLD) through a randomized open parallel-controlled study. Methods: The patients aged 30-65 years who visited Tianjin Third Central Hospital from January 2013 to December 2014 and were diagnosed with NAFLD by liver ultrasound and fat content determination were screening, and 474 patients were enrolled in this randomized controlled trial and divided into aerobic exercise group, resistance exercise group, and control group. All patients received dietary intervention. The three groups were compared in terms of biochemical parameters, fat content, NFS score, energy metabolic parameters, body composition index, and levels of vaspin and irisin at baseline and after 6 months of intervention. SPSS 19.0 was used for statistical analysis. The t-test, the Mann-Whitney U test, the chi-square test, and an analysis of variance were used for comparison between groups. The multiple imputation method was used for missing data, and the results were included in the intention-to-treat analysis. Results: There were no significant differences in age, sex, anthropometrical parameters, and biochemical parameters between the three groups at baseline. Compared with dietary control alone, aerobic exercise and resistance exercise helped to achieve significant reductions in waist circumference, diastolic pressure, percentage of body fat, volatile fatty acid, fasting blood glucose, homeostasis model assessment of insulin resistance, triglyceride, low-density lipoprotein cholesterol, free fatty acid, uric acid, alanine aminotransferase, and liver fat content after 6 months of intervention (P < 0.05). The aerobic exercise group had a significant increase in non-protein respiratory quotient and significant reductions in body mass index and aspartate aminotransferase after intervention, as well as a significant increase in resting energy expenditure and significant reductions in abdominal fat ratio and total cholesterol after 6 months of resistance exercise (P < 0.05). The aerobic exercise group and the resistance exercise group had a significant reduction in vaspin and a significant increase in irisin after intervention (P < 0.05), and the resistance exercise group had significantly greater changes in these two adipokines than the aerobic exercise group (P < 0.05). Conclusion: Exercise therapy is an effective method for the treatment of metabolism-associated diseases, and a combination of resistance and aerobic exercises is more reasonable and effective in clinical practice. As a relatively safe exercise mode, resistance exercise can also effectively improve the metabolic state of NAFLD patients.

[Influence of high-fat diet in paternal C57BL/6 mice on liver fat deposition in offspring].

Objective: To investigate the influence of high-fat diet (HFD) in paternal C57BL/6 mice on HFD-induced liver fat deposition in male offspring, as well as transgenerational inheritance caused by paternal HFD and related mechanisms. Methods: A total of 20 male C57BL/6 mice aged 3 weeks (F0) were randomly divided into normal control group (C, 10 mice) and HFD group (HF, 10 mice). After 12 weeks of HFD intervention, the male mice in the HFD group mated with female ones treated with normal diet and pups were obtained. Male pups (F1) were selected as study subjects. According to the intervention for F0 mice, male F1 mice were divided into control male offspring group (CM, 8 mice) and HFD male offspring group (HFM, 9 mice). All these mice were given normal diet after weaning until 4 weeks old, followed by HFD for 4 weeks. The body length and body weight were measured and recorded every week. Oil red O staining was used to observe fat deposition in the liver. Western blot and real-time PCR were used to measure the expression of related proteins and genes involved in the de novo synthesis and aerobic oxidation of fatty acid, mitochondriogenesis, and autophagy. Results: After 4 weeks of HFD intervention, the HFM group had a significantly higher body weight than the CM group (P < 0.05); the oil red O staining showed that compared with the CM group, the HFM had a significant increase in liver fat deposition and a significantly higher integral absorbance value in the oil red O staining-positive area (384 360±57 600 vs 236 754±12 607, P < 0.01). For related factors involved in the de novo synthesis of fatty acid in the liver, compared with the CM group, the HFM group had significant increases in the expression of sterol regulatory element-binding protein-1 and fatty acid synthase (P < 0.05); for related factors involved in the mitochondrial biosynthesis in the liver, the HFM group had significant reductions in the relative expression of peroxisome proliferator-activated receptor-γ coactivator-1α, nuclear respiratory factor 1, and mitochondrial transcription factor A compared with the CM group (P < 0.05). For autophagy-related factors in the liver in the F1 mice, compared with the CM group, the HFM group had a significant reduction in microtubule-associated protein I light chain 3 (LC3-II/I) (P < 0.05) and a significant increase in P62 (P < 0.05), suggesting a reduced autophagy function in the liver. Conclusion: HFD intervention for paternal C57BL/6 mice can increase HFD-induced liver fat deposition in male offspring, which may be related to the increased de novo synthesis of fatty acid and reduced mitochondriogenesis and autophagy function in the liver.