Cardiff Metropolitan University
Exercise training reverses endothelial dysfunction in nonalcoholic fatty liver disease-Pugh C.pdf (566.48 kB)

Exercise training reverses endothelial dysfunction in nonalcoholic fatty liver disease

Download (566.48 kB)
journal contribution
posted on 2022-08-10, 11:39 authored by Chris PughChris Pugh, Victoria S. Sprung, Graham J. Kemp, Paul Richardson, Fariba Shojaee-Moradie, A. Margot Umpleby, Daniel J. Green, N. Timothy Cable, Helen Jones, Daniel J. Cuthbertson

 Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular disease (CVD). Endothelial dysfunction is an early manifestation of atherosclerosis and an important prognostic marker for future cardiovascular events. The aim of this study was twofold: to examine 1) the association between liver fat, visceral adipose tissue (VAT), and endothelial dysfunction in obese NAFLD patients and 2) the impact of supervised exercise training on this vascular defect. Brachial artery endothelial function was assessed by flow-mediated dilatation (FMD) in 34 obese NAFLD patients and 20 obese controls of similar age and cardiorespiratory fitness [peak oxygen uptake (V˙ O2 peak)] (48 ! 2 vs. 47 ! 2 yr; 27 ! 1 vs. 26 ! 2 ml·kg"1·min"1"1). Magnetic resonance imaging and spectroscopy quantified abdominal and liver fat, respectively. Twenty-one NAFLD patients completed either 16 wk of supervised moderate-intensity exercise training (n # 13) or conventional care (n # 8). Differences between NAFLD and controls were compared using independent t-tests and effects of interventions by analysis of covariance. NAFLD patients had higher liver fat [11.6% (95% CI # 7.4, 18.1), P $ 0.0005] and VAT [1.6 liters (95% CI # 1.2, 2.0), P $ 0.0001] than controls and exhibited impaired FMD compared with controls ["3.6% (95% CI # "4.9, "2.2), P $ 0.0001]. FMD was inversely correlated with VAT (r # "0.54, P # 0.001) in NAFLD, although the impairment in FMD remained following covariate adjustment for VAT [3.1% (95% CI # 1.8, 4.5), P $ 0.001]. Exercise training, but not conventional care, significantly improved V˙ O2 peak [9.1 ml·kg"1·min"1 (95% CI # 4.1, 14.1); P #0.001] and FMD [3.6% (95% CI # 1.6, 5.7), P # 0.002]. Endothelial dysfunction in NAFLD cannot be fully explained by excess VAT but can be reversed with exercise training; this has potential implications for the primary prevention of CVD in NAFLD 


We would like to thank the European Foundation for the Study of Diabetes for funding this study [09/H1008/1]


Published in

American Journal of Physiology; Heart and Circulatory Physiology


American Physiological Society


  • AM (Accepted Manuscript)


Pugh C.J., Sprung V.S., Kemp G.J., Richardson P., Shojaee-Moradie F., Umpleby A.M., Green D.J., Cable N.T., Jones H. and Cuthbertson D.J. (2014) 'Exercise training reverses endothelial dysfunction in nonalcoholic fatty liver disease', American Journal of Physiology; Heart & Circulatory Physiology, 307(9), H1298-1306

Print ISSN


Cardiff Met Affiliation

  • Cardiff School of Sport and Health Sciences

Cardiff Met Authors

Christopher J.A. Pugh

Cardiff Met Research Centre/Group

  • Cardiovascular Physiology

Copyright Holder

  • © The Publisher


  • en

Usage metrics

    Cardiovascular Health & Ageing - Journal Articles


    Ref. manager