Life style modification improves insulin resistance and liver histology in patients with non-alcoholic fatty liver disease

Table 1 Histological characteristics of nonalcoholic steatohepatitis on liver biopsy

Histological finding	n = 32
Steatosis
Grade 1	12
Grade 2	15
Grade 3	5
Ballooning degeneration	8
Glycogenated nuclei	11
Necroinflammatory activity
Grade 1	10
Grade 2	17
Grade 3	5
Staging fibrosis
Stage 0	11
Stage 1	14
Stage 2	4
Stage 3	3

Table 2 Components of metabolic syndrome seen in our patients n = 60 (%) according to National Cholesterol Education Program adult treatment panel III and waist modified by Indian criteria

Components present	NCEP ATP III	Indian criteria
None	7 (12)	1 (2)
1	20 (34)	13 (22)
2	23 (38)	24 (40)
3	8 (13)	18 (30)
4	2 (4)	4 (7)

NCEP ATP III: National Cholesterol Education Program adult treatment panel III.

Table 3 Baseline demographic, anthropometric and biochemical characteristics of patients

Characteristic	Non-compliant (n = 15)	Compliant group (n = 45)	P value1
Age (yr)	39.6 ± 8.9	40.1 ± 9.0	NS
Gender (Males)	9	37
BMI (kg/m2)	27.6 ± 3.8	26.7 ± 3.3	NS
< 25	6	15
25-30	6	20
> 30	3	10
WC	98.0 ± 8.6	95.7 ± 8.9	NS
Fasting glucose (mg/dL)	86.4 ± 11.3	86.8 ± 14.3	NS
2 h glucose (mg/dL)	128.2 ± 43.5	123.5 ± 41.8	NS
Serum albumin (g/dL)	3.9 ± 0.4	4.0 ± 0.4	NS
AST (U/L)	78.3 ± 460.2	76.2 ± 46.2	NS
ALT (U/L)	82.0 ± 45.0	84.8 ± 43.5	NS
Total cholesterol (mg/dL)	202.2 ± 45.0	194.6 ± 62.0	NS
Triglycerides (mg/dL)	178.5 ± 102.6	186.4 ± 112.5	NS
LDL (mg/dL)	114.5 ± 43.5	120.4 ± 56.4	NS
HDL (mg/dL)	38.5 ± 18.5	37.4 ± 8.6	NS

¹Mann Whitney U test. BMI: Body mass index; WC: Waist circumference; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; LDL: Low-density lipoprotein; HDL: High-density lipoprotein. NS: Not significant.

Table 4 Sub-group analysis of the compliant group - exercise alone and both exercise and diet modification and comparison with non-compliant group

Variable	Non-compliant (n = 15)			Exercise (n = 12)			Exercise and diet (n = 33)
	Pre	Post	P value1	Pre	Post	P value1	Pre	Post	P value1
BMI (kg/m2)	27.6 ± 3.8	27.7 ± 3.5	NS	23.0 ± 1.4	21.7 ± 1.6	NS	28.5 ± 2.4	26.6 ± 2.7	< 0.001
WC (cm)	99.2 ± 7.00	98.7 ± 8.4	NS	88.0 ± 7.0	85.4 ± 7.2	0.001	99.5 ± 7.2	93.6 ± 5.5	< 0.001
WHR	0.9 ± 0.3	0.9 ± 0.1	NS	0.9 ± 0.3	0.9 ± 0.1	0.006	0.9 ± 0.6	0.9 ± 0.1	0.001
ALT (U/L)	82.0 ± 45.0	78.2 ± 18.6	NS	69.8 ± 32.3	34.6 ± 13.1	0.001	90.3 ± 46.1	43.8 ± 19.4	0.001
HOMA-IR	8.7 ± 4.1	10.5 ± 9.8	NS	6.2 ± 4.6	1.2 ± 0.8	0.002	6.5 ± 4.4	1.4 ± 1.1	< 0.001

¹Wilcoxon signed rank test. BMI: Body mass index; WC: Waist circumference; WHR: Waist-hip ratio; ALT: Alanine aminotransferase; HOMA-IR: Homeostasis model assessment-estimated insulin resistance. NS: Not significant.

Table 5 Anthropometric, biochemical and histological characteristics of patients with paired liver biopsy (n = 8)

Variable	Pre-intervention	Post-intervention	P value1
BMI (kg/m2)	27.6 ± 3.8	26.0 ± 2.4	0.012
WC (cm)	96.3 ± 7.6	91.0 ± 6.3	0.01
ALT (U/L)	99.8 ± 37.2	34.0 ± 16.8	0.01
HOMA-IR	6.1 ± 3.8	1.04 ± 0.5	0.01
NASH score	5.3 ± 1.5	3.3 ± 1.5	0.02

¹Wilcoxon sign rank test. BMI: Body mass index; WC: Waist circumference; ALT: Alanine aminotransferase; HOMA-IR: Homeostasis model assessment-estimated insulin resistance; NASH: Nonalcoholic steatohepatitis.

Table 6 Correlation between improvement in nonalcoholic steatohepatitis score and anthropometry, biochemical characteristics

Variable	rs	P value1
BMI (kg/m2)	0.62	0.05
WC (cm)	0.68	0.04
ALT (U/L)	0.54	0.05
HOMA-IR	0.73	0.03

¹Spearman correlation. BMI: Body mass index; WC: Waist circumference; ALT: Alanine aminotransferase; HOMA-IR: Homeostasis model assessment-estimated insulin resistance.