Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis


Dr Gourdas Choudhuri, MD, Professor and Head, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India. Email: gc@sgpgi.ac.in; gourdas@satyam.net.in


Background:  Nonalcoholic steatohepatitis (NASH) is commonly associated with overweight and insulin resistance. Aerobic exercise is known to reduce insulin resistance. We studied the effect of regular aerobic exercise on serum aminotransferase levels in patients with NASH.

Methods:  Sixty-five (mean age 38.7 ± 9.5 years; 46 [78%] males) out of 94 patients diagnosed with NASH participated in the study. Each patient was advised regular aerobic exercise for 30 min duration per day, and trained to achieve a heart rate of 60–70% of his/her maximal heart rate for at least 5 days a week. In addition, those with a high body mass index (BMI) were advised a moderately energy-restricted diet. Patients were followed up monthly for at least 3 months by BMI, waist-hip ratio (WHR), waist circumference (WC), aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

Results:  Forty-three (72.8%) patients had a high BMI. Central obesity (WHR ≥0.90 cm in men and ≥0.85 cm in women) was present in 58 (98.3%) patients and metabolic syndrome in 12 (20.3%) patients. In the 44 patients who complied regularly with the exercise program, serum ALT normalized in 20 (45%; P < 0.05), and mean AST and ALT values declined from 70.5 and 104.0–41.5 (P < 0.001) and 63.2 (P < 0.001), respectively. Overweight patients lost a mean 3.1 kg (range 0–13 kg) weight and showed a decline in BMI (28.7 vs 27.5; P < 0.001) and WC (99.4 cm vs 96.1 cm; P = 0.001). Serum ALT did not normalize in any of the 15 patients who failed to comply with the exercise program; their pre- and post-AST (82.8 and 81.2, respectively) and ALT (98.0 and 96.1, respectively) levels, BMI (27.5 and 27.6, respectively) and WHR (0.99 cm and 0.99 cm, respectively) did not show any significant change at 3 months, and also for an extended mean follow-up period of 5.3 months.

Conclusion:  Moderate intensity aerobic exercise helps in normalizing ALT levels in patients with NASH.