Exercise and ectopic fat in type 2 diabetes: A systematic review and meta-analysis.
Ectopic adipose tissue surrounding the intra-abdominal organs (visceral fat) and located in the liver, heart, pancreas and muscle, is linked to cardio-metabolic complications commonly experienced in type 2 diabetes. A systematic review and meta-analysis was performed to determine the effect of exercise on ectopic fat in adults with type 2 diabetes. Relevant databases were searched to February 2016. Included were randomised controlled studies, which implemented≥4 weeks of aerobic and/or resistance exercise and quantified ectopic fat via magnetic resonance imaging, computed tomography, proton magnetic resonance spectroscopy or muscle biopsy before and after intervention. Risk of bias and study quality was assessed using Egger's funnel plot test and modified Downs and Black checklist, respectively. Of the 10,750 studies retrieved, 24 were included involving 1383 participants. No studies were found assessing the interaction between exercise and cardiac or pancreas fat. One study assessed the effect of exercise on intramyocellular triglyceride concentration. There was a significant pooled effect size for the meta-analysis comparing exercise vs. control on visceral adiposity (ES=-0.21, 95% CI: -0.37 to -0.05; P=0.010) and a near-significant pooled effect size for liver steatosis reduction with exercise (ES=-0.28, 95% CI: -0.57 to 0.01; P=0.054). Aerobic exercise (ES=-0.23, 95% CI: -0.44 to -0.03; P=0.025) but not resistance training exercise (ES=-0.13, 95% CI: -0.37 to 0.12; P=0.307) was effective for reducing visceral fat in overweight/obese adults with type 2 diabetes. These data suggest that exercise effectively reduces visceral and perhaps liver adipose tissue and that aerobic exercise should be a key feature of exercise programs aimed at reducing visceral fat in obesity-related type 2 diabetes. Further studies are required to assess the relative efficacy of exercise modality on liver fat reduction and the effect of exercise on pancreas, heart, and intramyocellular fat in type 2 diabetes and to clarify the effect of exercise on ectopic fat independent of weight loss.
Faculty of Health Sciences, University of Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia.
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Sabag
Faculty of Health Sciences, University of Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia.
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Way
Faculty of Health Sciences, University of Sydney, NSW, Australia; Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Queensland, Australia.
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Keating
Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia; School of Exercise Science, Australian Catholic University, NSW, Australia.
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Sultana
Faculty of Health Sciences, University of Sydney, NSW, Australia.
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O'Connor
Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia; School of Exercise Science, Australian Catholic University, NSW, Australia.
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Baker
School of Health Sciences, University of Newcastle, NSW, Australia.
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Chuter
Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, NSW, Australia.
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George
Faculty of Health Sciences, University of Sydney, NSW, Australia; Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW, Australia. Electronic address: nathan.johnson@sydney.edu.au.
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Johnson
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D055070:Resistance Training
Aerobic exercise; Ectopic fat; Hepatic fat; Resistance training; Visceral fat