Effect of aerobic exercise and low carbohydrate diet on pre-diabetic non-alcoholic fatty liver disease in postmenopausal women and middle aged men--the role of gut microbiota composition: study protocol for the AELC randomized controlled trial.
BACKGROUND
Pre-diabetes and non-alcoholic fatty liver disease (NAFLD) are associated with an unhealthy lifestyle and pose extremely high costs to the healthcare system. In this study, we aim to explore whether individualized aerobic exercise (AEx) and low carbohydrate diet (LCh) intervention affect hepatic fat content (HFC) in pre-diabetes via modification of gut microbiota composition and other post-interventional effects.


METHODS
A 6-month randomized intervention with 6-month follow-up is conducted from January 2013 to December 2015. The target sample size for intervention is 200 postmenopausal women and middle-aged men aged 50-65 year-old with pre-diabetes and NAFLD. The qualified subjects are randomized into 4 groups with 50 subjects in each group: 1 = AEx, 2 = LCh, 3 = AEx + LCh, and 4 = control. In addition, two age-matched reference groups (5 = pre-diabetes without NAFLD (n = 50) and 6 = Healthy without pre-diabetes or NAFLD (n = 50)) are included. The exercise program consists of progressive and variable aerobic exercise (intensity of 60 to 75% of initial fitness level, 3-5 times/week and 30-60 min/time). The diet program includes dietary consultation plus supplementation with a special lunch meal (40% of total energy intake/day) which aims to reduce the amount of carbohydrate consumption (30%). The control and reference groups are advised to maintain their habitual habits during the intervention. The primary outcome measures are HFC, serum metabolomics and gut microbiota composition. The secondary outcome measures include body composition and cytokines. In addition, socio-psychological aspects, social support, physical activity and diet will be performed by means of questionnaire and interview.


CONCLUSIONS
Specific individualized exercise and diet intervention in this study offers a more efficient approach for liver fat reduction and diabetes prevention via modification of gut microbiota composition. Besides, the study explores the importance of incorporating fitness assessment and exercise in the management of patients with pre-diabetes and fatty liver disorders. If our program is shown to be effective, it will open new strategies to combat these chronic diseases.


BACKGROUND
Current Controlled Trials: ISRCTN42622771.
Wu Yi
WY
Liu
Da Jiang
DJ
Lu
Xia Ming
XM
Du
Jian Qin
JQ
Sun
Jun
J
Ge
Ren Wei
RW
Wang
Ru
R
Wang
Jun
J
Zou
Chang
C
Xu
Jie
J
Ren
Xin Fei
XF
Wen
Yang
Y
Liu
Shu Mei
SM
Cheng
Xiao
X
Tan
Satu
S
Pekkala
Eveliina
E
Munukka
Petri
P
Wiklund
Yan Qiu
YQ
Chen
Qing
Q
Gu
Zheng Chang
ZC
Xia
Jun Jun
JJ
Liu
Wen Bin
WB
Liu
Xue Bo
XB
Chen
Yi Min
YM
Zhang
Rui
R
Li
Ronald J H
RJ
Borra
Jia Xin
JX
Yao
School of Kinesiology, Shanghai University of Sport, 200438 Shanghai, China. chenpeijie@sus.edu.cn.
Pei Jie
PJ
Chen
Sulin
S
Cheng
D000368:Aged; D001823:Body Composition; D050528:Diet, Carbohydrate-Restricted; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000009:adverse effects; D019587:Dietary Supplements; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008099:Liver / Q000473:pathology; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000628:therapy*; D017698:Postmenopause; D011236:Prediabetic State / Q000150:complications / Q000628:therapy*; D012107:Research Design; D011795:Surveys and Questionnaires
D004040:Dietary Carbohydrates