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Invited Commentary | Less Is More

Moderate Exercise for Nonalcoholic Fatty Liver Disease

Stacey Prenner, MD1; Mary E. Rinella, MD1
[+] Author Affiliations
1Division of Gastroenterology and Hepatology, Northwestern University Feinberg, School of Medicine, Chicago, Illinois
JAMA Intern Med. 2016;176(8):1083-1084. doi:10.1001/jamainternmed.2016.3221.
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Long-term nutritional excess coupled with reduced physical activity has fueled the rise of obesity-related metabolic conditions. In many countries with high population density, overnutrition is now responsible for more morbidity than undernutrition. Nonalcoholic fatty liver disease (NAFLD) is 1 of the consequences of the imbalance between caloric intake and expenditure and is a leading cause of chronic liver disease, affecting up to 30% of the world’s population. Nonalcoholic fatty liver disease is associated with significant morbidity, particularly for those with the progressive version nonalcoholic steatohepatitis. Nonalcoholic steatohepatitis may progress to cirrhosis, with mortality primarily driven by cardiovascular disease and malignant tumors. Nonalcoholic fatty liver disease is strongly associated with visceral obesity and may contribute independently to the development of other metabolic conditions, such as diabetes, cardiovascular disease, and hyperlipidemia.

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Figure.
Benefits of Exercise and Weight Loss on Adipose Tissue Compartments and Insulin Resistance

Exercise alone can reduce hepatic steatosis and have a modest effect on visceral adipose tissue, but additional weight loss can provide a greater effect on visceral adipose tissue and subcutaneous adipose tissue. Weight loss first improves visceral adipose tissue followed by subcutaneous adipose tissue. Improvement in insulin resistance occurs with improvement in visceral adipose tissue.

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