TOPLINE:

In adults with metabolic dysfunction-associated steatohepatitis (MASH), 20 weeks of moderate-intensity aerobic exercise led to disease resolution more than twice as often as standard care, as well as improvement in biomarkers including alanine aminotransferase (ALT) and MRI proton density fat fraction (MRI-PDFF).

METHODOLOGY:

• Although physical activity can reduce liver fat and inflammation independent of weight loss, no paired liver‐biopsy studies have shown that exercise alone reverses fibrosis in MASH.
• Investigators performed a post hoc analysis of the NASHFit trial using a validated composite score of multiple biomarkers (the MASH Resolution Index [MASH-RI]) to assess exercise-driven changes in liver histology.
• In the NASHFit trial, adults with biopsy-proven MASH were randomly assigned to moderate-intensity aerobic exercise training (five 30-minute sessions/wk) or standard care for 20 weeks; MASH-RI changes were available for 23 participants (exercise group, n = 15; standard-of-care group, n = 8).
• The primary endpoint was the proportion of patients achieving MASH resolution (MASH-RI score > -0.67) at 20 weeks.

TAKEAWAY:

• A higher proportion of patients in the exercise group vs standard-of-care group achieved MASH resolution (33% vs 13%; P < .01). Improvements occurred independent of significant (≥ 5%) weight loss.
• Reductions in ALT also favored the exercise group: 53% achieved a ≥ 17 IU/L decrease compared with 13% in the standard-of-care group (P < .001).
• MRI-PDFF improved more often in the exercise group: 36% achieved a ≥ 30% relative reduction vs 13% in the standard-of-care group (P = .016).

IN PRACTICE:

“Exercise and dieting can improve MASH independent of significant weight loss, and emphasizing these benefits may help support more sustainable lifestyle changes in clinical practice, thereby enhancing patient motivation and engagement in long-term care,” the authors wrote.

SOURCE:

The study was led by Theja Channapragada, Department of Medicine, Penn State Health-Milton S. Hershey Medical Center in Hershey, Pennsylvania. It was published online in Digestive Diseases and Sciences.

LIMITATIONS:

A modest sample size, a predominantly non-Hispanic White cohort, and relatively short intervention and follow-up limit generalizability. The MASH-RI lacked data linking it to clinical outcomes, and no postintervention liver biopsies were performed. 

DISCLOSURES:

The study received support from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, the Pennsylvania Department of Health via Tobacco CURE Funds, and other sources. The authors declared being consultants or advisory board members and employees of, receiving research and grant support from, and having other ties with several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.