@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(4): 301-308

Background
Non-alcoholic fatty liver disease (NAFLD) is defined as a liver manifestation of metabolic syndrome or insulin resistance, and its prevalence has increased with the incidence of obesity and type 2 diabetes [1].
Previous Studies
... [2-5]. NAFLD is associated with an increase in coronary artery calcification, endothelial dysfunction, arterial stiffness, and the elevated cIMT [6]. ... [7]. An increase in cIMT is associated with aging, hypertension and physical inactivity [8]. Insulin resistance, visceral obesity, and impairment of lipid profiles can lead to an increase in cIMT [9]. On the other hand, an increase in physical activity may delay cIMT elevation [10]. ... [11, 12]. Wildman et al. reported that long-term changes in the lifestyles of middle-aged women through diet and exercise can delay the increased cIMT [13]. In another study, Rauramaa et al. reported that long-term exercise without a change in diet would delay the increase in cIMT in middle-aged men [14]. ... [15].
Aim(s)
The purpose of this study was to investigate the combination effect of aerobic training and low-calorie diet on body composition, blood pressure and cIMT in men with NAFLD.
Research type
The present quasi-experimental study is a randomized, one-blind randomized control trial.
Research society, place and time
This study was conducted on patients referred to the Diabetes Clinic of Imam Khomeini Hospital in Ardabil in 2016.
Sampling method and number
17 subjects were selected for each group by convenience sampling method.
Used devices&materials
The present study was approved by the Ethics Committee for Biomedical Research of Ardabil University of Medical Sciences (IR.ARUMS.REC.1395.93) and registered at the Iranian Center for Clinical Trials (IRCT2016102330450N1). The research designed based on pre-test and post-test with control group. ... [16]. Participants attending the Diabetes Clinic of Imam Khomeini Hospital in Ardabil completed the medical records and physical activity records (none of the subjects were diabetic). They were assured of confidentiality of information and they made sure that there is no need to mention their names and eventually will be reported generally. At the end, after obtaining written consent from the subjects, they were randomly divided into two groups: aerobic exercise, low calorie diet (17 subjects) and control group (17 subjects). Inclusion criteria included Grade 2 and 3 NAFLD, age range of 35-45 years, body mass index greater than 25 kg/m2, waist to hip ratio greater than 0.9 cm, no participation in weight loss programs during the past six months, no alcohol use and lipid lowering drugs, etc. Exclusion criteria included cardiovascular, kidney and pulmonary diseases, skeletal injuries, taking weight-loss medications, participation in other sports programs or changing in physical activity, using supplements, diuretics, laxatives and hepatic steatosis drugs during the intervention period and the personal desire to withdraw from the study. The aerobic exercise and low calorie diet group experienced endurance training for eight weeks, including running with a moderate intensity of 50-75% of maximum heart rate for 45 min per session and three times a week alternately on a treadmill. At the end of the training session, they were subjected to 10 min of warm-up exercises including gentle stretching movements at the beginning of the training and 10 min of cool down exercises at the end of training [17]. ... [18]. Blood samples were taken from the subjects in the pre-test and post-test (after eight weeks of training) in order to evaluate biochemical variables. In the pre-test, after 12 h of fasting at about 8:30 am, blood samples (10 cc) were taken from the left ventricle of the subjects in sitting position. In the post-test, 36 h after the last training session, after 12 h of fasting, blood samples were collected to prevent acute effects of exercise. The samples were evaluated and biochemical analysis was performed. The serum levels of alanine aminotransferase and aspartate aminotransferase were measured by ELISA method and total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were measured by enzymatic method using Pars Tests. All quantitative variables were analyzed using Shapiro-Wilk test and independent t-test (for normal distribution and no significant difference between groups, respectively), independent t-test and paired t-test using SPSS 20 software.
Findings by Text
The total number of subjects for the final analysis was 15 subjects in the aerobic exercise and low calorie diet group and 16 samples in the control group. Through the study, two subjects in aerobic exercise and low calorie diet group were excluded from the study, due to knee pain and being busy and also one subject from the control group due to drug use excluded. Table 1 shows the normal distribution of all variables at the beginning of the study (p>0.05). Moreover, there was no significant difference between two groups in the initial values of the studied variables (p>0.05). Table 2 shows the changes in the anthropometric indices, biochemical indices, blood pressure and the carotid intima-media thickness in the post-test than pre-test. Mean±standard deviation of total weight of the subjects at the beginning of the study was 91.6±2.4 and the body mass index obtained 29.7±1.2 kg/m2. The total mean±standard deviation of alanine aminotransferase and aspartate aminotransferase in the beginning of the study in all subjects were 99.5±6.3 and 38.6±9.2, respectively. The total mean±standard deviation of the right and left intima-media thickness of the subjects at the beginning of the study were 0.79±0.62 mm and 0.81±0.34 mm, respectively. Based on the results of t-test in the intervention group, except for diastolic blood pressure, weight (t(14)=-6.65; p=0.001), BMI (t(14)=-1.9; P=0.12), waist to hip ratio (t(14)=-0.13; p=0.007) and systolic blood pressure (t(14)=-6.2; p=0.001) decreased significantly in post-test compared with pre-test. In addition, alanine aminotransferase (t(14)=-17.2; p=0.023), aspartate aminotransferase (t(14)=-14.8; p=0.11), high density lipoprotein (t(14)=-12.6; p=0.004), low density lipoprotein (t(14)=-32.3; p=0.001, triglyceride (t(14)=-51.2; p=0.001) and total cholesterol (t(14)=-34.7; p=0.001) significantly decreased. The right intima-media thickness (t(14)=-0.03; p=0.001) and the left intima-media thickness (t(14)=-0.03; p=0.018) significantly reduced in the post-test than pre-test. However, no significant difference was observed in the studied variables in the control group (p>0.05). Also, there was a significant difference between two groups in weight, systolic blood pressure, aspartate aminotransferase, total cholesterol, right and left intima-media thickness (p=0.001). In addition, the mean BMI (p=0.01), waist to hip ratio (p=0.021), diastolic blood pressure (p=0.01), alanine aminotransferase (p=0.024), high density lipoprotein (p=0.19), low density lipoprotein (p=0.036) and triglyceride (p=0.002) were significantly different in the post-test.
Main comparison to the similar studies
... [19]. The results of this study are consistent with the results of Byrkjeland et al. study on the effect of exercise on coronary heart disease and Mahdavi-roshan et al. on the effect of garlic on cIMT [15,20]. Based on previous studies, changes in cIMT thickness due to sport and nutritional interventions are associated with some risk factors, including antioxidant defense, shear stress, inflammatory processes, sympathetic nervous system activation and vascular tone [21]. ... [22-24]. Positive effects of weight loss have been shown in several studies [25]. Weight loss diet improves lipid and glucose metabolism by increasing insulin sensitivity, endothelial function improvement, lowering blood pressure, decreasing pro-inflammatory markers, and decreasing insulin resistance [26]. ... [27, 28].
Suggestions
None declared.
Limitations
The small sample size and the short time of intervention were the limitations of this study.
Conclusions
Eight weeks of aerobic exercise combined with low calorie diet improves body composition, blood pressure and cIMT in men with NAFLD.
Acknowledgments
We sincerely thank all subjects and the staff of the Diabetes Clinic of Imam Khomeini Hospital in Ardebil, in particular Mr. Manouchehr Iran Parvoor, who collaborated with us in this study.
Conflict of interest
None declared.
Ethical Permissions
None declared.
Funding Sources
This study was supported by the Mohaghegh Ardabili University.

TABLES and CHARTS

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