Volume-dependent effect of supervised exercise training on fatty liver and visceral adiposity index in subjects with type 2 diabetes The Italian Diabetes Exercise Study (IDES) Stefano Balducci a,b,c , Patrizia Cardelli a,d , Luca Pugliese a,e , Valeria D’Errico a,b,c , Jonida Haxhi c,f , Elena Alessi a,c , Carla Iacobini a , Stefano Menini a , Lucilla Bollanti a,b , Francesco G. Conti a,b , Antonio Nicolucci g , Giuseppe Pugliese a, * for the Italian Diabetes Exercise Study (IDES) Investigators 1 a Department of Clinical and Molecular Medicine, ‘‘La Sapienza’’ University, Rome, Italy b Diabetes Unit, Sant’Andrea Hospital, Rome, Italy c Metabolic Fitness Association, Monterotondo, Rome, Italy d Laboratory of Clinical Chemistry, Sant’Andrea Hospital, Rome, Italy e Radiology Unit, Sant’Andrea Hospital, Rome, Italy f Department of Human Movement and Sport Sciences, ‘‘Foro Italico’’ University, Rome, Italy g Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e x x x ( 2 0 1 5 ) x x x – x x x a r t i c l e i n f o Article history: Received 3 December 2014 Received in revised form 26 February 2015 Accepted 2 May 2015 Available online xxx Keywords: Supervised exercise Exercise volume FLI VAI Liver enzymes a b s t r a c t Aims: This study evaluated the effect of supervised exercise training on liver enzymes and two surrogate measures of non-alcoholic fatty liver disease (NAFLD) in subjects with type 2 diabetes. Methods: Sedentary patients from 22 outpatient diabetes clinics were randomized by center, age and treatment to twice-a-week supervised aerobic and resistance training plus struc- tured exercise counseling (exercise group, EXE; n = 303) versus counseling alone (control group, CON; n = 303) for 12 months. EXE participants were further randomized to low-to- moderate (n = 142) or moderate-to-high (n = 161) intensity training of equal energy cost. Baseline and end-of-study levels of liver enzymes, fatty liver index (FLI) and visceral adiposity index (VAI) were obtained. Results: Enzyme levels did not change, whereas FLI and VAI decreased significantly in EXE, but not CON participants. Physical activity (PA) volume was an independent predictor of both FLI and VAI reductions, the extent of which increased from the 1st to the 4th quintile of * Corresponding. author at: Department of Clinical and Molecular Medicine, ‘‘La Sapienza’’ University of Rome, Via di Grottarossa, 1035-1039—00189 Rome, Italy. Tel.: +39 0633775440; fax: +39 0633776327. E-mail address: giuseppe.pugliese@uniroma1.it (G. Pugliese). 1 A complete list of the IDES Investigators can be found as on-line Supplemental Material. Abbreviations: NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; FLI, fatty liver index; VAI, visceral adiposity index; PA, physical activity; IDES, Italian diabetes and exercise study; EXE, exercise group; CON, control group; LI, low-to- moderate intensity; HI, moderate-to-high intensity; VO 2max , maximal oxygen consumption; 1-RM, 1-repetition maximum; BP, blood pressure; HbA 1c , hemoglobin A 1c ; HOMA-IRh, omeostasis model assessment-insulin resistance; BMI, body mass index; hs-CRP, high sensitivity-C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; g-GT, g-glutamyl-transpeptidase; MET, metabolic equivalent. DIAB-6409; No. of Pages 9 Please cite this article in press as: Balducci S, et al. Volume-dependent effect of supervised exercise training on fatty liver and visceral adiposity index in subjects with type 2 diabetes The Italian Diabetes Exercise Study (IDES). Diabetes Res Clin Pract (2015), http://dx.doi.org/10.1016/ j.diabres.2015.05.033 Contents available at ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres http://dx.doi.org/10.1016/j.diabres.2015.05.033 0168-8227/# 2015 Published by Elsevier Ireland Ltd.