1. Independent Effects of Physical Activity in Patients with Nonalcoholic Fatty Liver Disease Hepatology, Vol 50, No 1 : 6~76, 2009 Alexis St. George, Adrian Bauman, Amanda Johnston, Geoffrey Farrell, Tien Chey, and Jacob George R2 이은정

2. Introduction NAFLD –commonest form of chronic liver disease –Elevated liver enzymes, metabolic risk The aims (1) the impact of a counseling-based lifestyle intervention on physical activity (PA) behavior (2) the relationship between changes in PA and fitness on liver enzymes and metabolic parameters (3) the extent of change in PA that is required to influence metabolic targets (4) whether the relationship between change and health outcomes was similar for both PA and objective cardiorespiratory fitness changes obesity, T2DM, insulin resistance

3. Patients and Methods Study group –enrolled from the Sydney West Area Health Service –NAFLD was diagnosed ; abnormal liver enzymes, a detailed history, and exclusion of other causes of liver disease –Other liver diseases ; hepatitis B (negative for HBs Ag), hepatitis C (negative for HCV Ab), autoimmune liver disease (ANA, AMA,, anti-LKM Ab), Wilson’s disease (serum copper and ceruloplasmin levels), alpha-1 antitrypsin deficiency (alpha-1 antitrypsin levels/genotype), and hemochromatosis (iron studies and genotyping for C268Y and H63D mutations) –alcohol >20 g/day in males and >10 g/day in females ; excluded

4. Patients and Methods Study design (141 patients were randomized) –Group A (n38) : low-intensity intervention (3 counseling sessions ; Baseline, Weeks 2 and 4) –Groups B (n33),C (n36) : moderate-intensity intervention in the first 3 months, comprising six fortnightly counseling sessions –Group C : additional longterm telephone support postintervention (3 to 12 months) to examine the effects of a maintenance program versus none –Control group (n34) : one consultation at baseline

5. Patients and Methods Measurement –To describe the effect of changes in PA : (1) increased PA (60 minutes/week) (2) those who maintained PA (above 150 minutes/ week at baseline and 3 months but did not increase) (3) low-active (decreased to or remained between 60-150 minutes/week) (4) sedentary (decreased to or remained at 60 minutes/week) –Weight change categorized ; reduction of 3% of initial body weight

6. Patients and Methods Statistical Analysis –SPSS software (version 16.0, Chicago, IL) –ANOVA ; identify between-group differences –paired t-tests for all continuous variables –For analysis between groups, ANCOVA was used –Logistic regression analysis ; compare the prevalence of risk factors between groups at 3 months, with baseline –McNemars test was used and Pearson’s chi-square test was used to compare categorical data between groups

7. Results

8. No significant differences between anthropometric, metabolic variables or in physical activity

9. P<0.001

13. positive relationship between increasing PA and weight loss no clear relationship between PA increments and reductions in liver enzyme levels

14. Conclusion Lifestyle counseling interventions are effective in improving physical activity behavior Maintaining or increasing physical activity provides health benefits for patients with fatty liver, independent of changes in weight