Table2_Comparative efficacy of different exercise modalities on metabolic profiles and liver functions in non-alcoholic fatty liver disease: a network meta-analysis.docx

ObjectiveResearch evidence suggests that exercise is a potent therapeutic strategy for non-alcoholic fatty liver disease (NAFLD). Many investigations have delved into the curative potential of diverse exercise regimens on NAFLD. This investigation synthesizes findings from randomized controlled trials via a network meta-analysis to evaluate the efficacy of exercise-based interventions on NAFLD.
MethodsWe conducted a search across five electronic databases (Web of Science, EMBASE, PubMed, SCOPUS, and CNKI)to identify randomized controlled trials (RCTs) comparing the effects of different exercise modalities on metabolic profiles and liver functions in patients with NAFLD. The literature search was comprehensive up to 15, December 2023. The selected studies were subjected to a rigorous quality appraisal and risk of bias analysis in accordance with the Cochrane Handbook’s guidelines, version 5.1.0. We employed Stata/MP 17 for the network meta-analysis, presenting effect sizes as standardized mean differences (SMD).
ResultsThis study aggregated results from 28 studies, involving a total of 1,606 participants. The network meta-analysis revealed that aerobic exercise was the most effective intervention for improving BMI in patients with NAFLD, demonstrating a significant decrease in BMI (−0.72, 95%CI: −0.98 to −0.46; p < 0.05; Surface Under the Cumulative Ranking (SUCRA) = 79.8%). HIIT was the top intervention for enhancing HDL-C (0.12, 95% CI: 0.04 to 0.20; p < 0.05; SUCRA = 76.1%). Resistance exercise was the most effective for reducing LDL-C (−0.20, 95% CI: −0.33 to −0.06; p < 0.05; SUCRA = 69.7%). Mind-body exercise showed superior effectiveness in improving TC (−0.67, 95% CI: −1.10 to −0.24; p < 0.05; SUCRA = 89.7%), TG = −0.67, 95% CI: −1.10 to −0.24; p < 0.05; SUCRA = 99.6%), AST (−8.07, 95% CI: −12.88 to −3.25; p < 0.05; SUCRA = 76.1%), ALT (−12.56, 95% CI: −17.54 to −7.58; p < 0.05; SUCRA = 99.5%), and GGT (−13.77, 95% CI: −22.00 to −5.54; p < 0.05; SUCRA = 81.8%).
ConclusionThis network meta-analysis demonstrates that exercise interventions positively affect various metabolic profiles and liver functions in NAFLD patients. Mind-body exercises are particularly effective, surpassing other exercise forms in improving metabolic profiles and liver functions.
Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier registration number CRD42024526332.

研究背景
研究证据表明，运动是非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）的有效治疗策略。诸多研究已探索了不同运动方案对NAFLD的治疗潜力。本研究通过网络meta分析整合随机对照试验的研究结果，以评估基于运动的干预手段对NAFLD的疗效。

研究方法
本研究检索了5个电子数据库（Web of Science、EMBASE、PubMed、SCOPUS及中国知网（China National Knowledge Infrastructure, CNKI）），旨在识别对比不同运动方式对NAFLD患者代谢指标与肝功能影响的随机对照试验（randomized controlled trial, RCT）。文献检索的截止时间为2023年12月15日。纳入的研究依据Cochrane手册5.1.0版指南进行严格的质量评价与偏倚风险分析。本研究采用Stata/MP 17软件开展网络meta分析，以标准化均数差（standardized mean difference, SMD）作为效应量进行呈现。

研究结果
本研究共纳入28项研究，涉及1606名受试者。网络meta分析结果显示，有氧运动是改善NAFLD患者体质量指数（body mass index, BMI）的最优干预手段，可显著降低BMI（−0.72，95%CI：−0.98至−0.46；p < 0.05；累积排序曲线下面积（Surface Under the Cumulative Ranking, SUCRA）=79.8%）。高强度间歇训练（high-intensity interval training, HIIT）是提升高密度脂蛋白胆固醇（high-density lipoprotein cholesterol, HDL-C）的最优干预手段（0.12，95%CI：0.04至0.20；p < 0.05；SUCRA=76.1%）。抗阻运动是降低低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）的最有效方式（−0.20，95%CI：−0.33至−0.06；p < 0.05；SUCRA=69.7%）。身心运动在改善总胆固醇（total cholesterol, TC）（−0.67，95%CI：−1.10至−0.24；p < 0.05；SUCRA=89.7%）、甘油三酯（triglyceride, TG）（−0.67，95%CI：−1.10至−0.24；p < 0.05；SUCRA=99.6%）、天冬氨酸氨基转移酶（aspartate aminotransferase, AST）（−8.07，95%CI：−12.88至−3.25；p < 0.05；SUCRA=76.1%）、丙氨酸氨基转移酶（alanine aminotransferase, ALT）（−12.56，95%CI：−17.54至−7.58；p < 0.05；SUCRA=99.5%）及γ-谷氨酰转移酶（gamma-glutamyl transferase, GGT）（−13.77，95%CI：−22.00至−5.54；p < 0.05；SUCRA=81.8%）方面均表现出更优的疗效。

研究结论
本项网络meta分析证实，运动干预可对NAFLD患者的多项代谢指标与肝功能产生积极影响。其中身心运动的疗效尤为突出，在改善代谢指标与肝功能方面优于其他运动形式。

系统评价注册
系统评价注册平台：https://www.crd.york.ac.uk/PROSPERO/，注册编号为CRD42024526332。