Journal of Metabolic Syndrome

Behavioral Determinants of Fatty Liver Index and of Nafld Responsiveness to a 10-Week Lifestyle Modification Program with Supervised Physical Exercises and Dietary Counseling

Abstract

Roberto Carlos Burini*, Franz Homero Paganini Burini, Hugo Tadashi Kano, Layene Peixoto Barros, Caroline das Neves Mendes Nunes, Camila Renata Correa and Mariana Santoro Nakagaki

Environmental-behavior determinants of Fatty-Liver Index (FLI) and of Non-Alcoholic Fatty-Liver Disease (NAFLD) responsiveness to a Lifestyle Modification (LiSM) were investigated in a dynamic cohort study. Baseline-data analysis of 1030 subjects (2005-2017) included medical, dietary (24h-food intake questionnaire and Healthy Eating Index-HEI calculation), physical activity (IPAQ), anthropometry, and plasma biochemistry. An algorithm based on BMI (Body Mass Index), waist circumference, triglycerides, and GGT (Gamma Glutamyl Transferase) was used to develop the FLI, which varies between 0 and 100 with FLI ≥ 60 ruling in NAFLD. Longitudinal analyses from 583 subjects submitted to a 10-wk LiSM intervention with daily supervised mixed-physical exercises (5x/wk, 80min/session/60-80% VO_2max) and dietary counseling. FLI values were split into quartiles (Q1-Q4) for comparison with co-variables and submitted to ANOVA with Tukey’s post hoc and significance level set at p=0.05. The top quartile of FLI was predominantly male, with lower schooling, lower income, lower physical activity, and inadequate HEI (98.8%). Multiple regression analysis revealed that increased FLI is associated with higher intake of fats, Carbohydrates (CHOs), and higher Na/K ratio in the diet. FLI was influenced by altered LDL-c and HDL-c, HOMA-IR, hs-CRP and MDA. After 10-wk LiSM, 95 subjects (16.3%) had reduced the>60 (M0) FLI. Hs-CRP and MDA were the main factors for positive responsiveness of FLI to LiSM. Thus, FLI was associated with low-quality diet with high-energy manufactured foods along with insulin resistance, pro- inflammatory, and elevated oxidative stress. The responsiveness to LiSM was associated with the decreasing of processed-refined foods and the reduced inflammatory-oxidative state.