اثر تمرین هوازی و محدودیت کالری بر نیمرخ لیپیدی، استئاتوز کبدی و تغییرات هورمونی در زنان یائسه‌ی مبتلا به کبد چرب غیر الکلی

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری گروه فیزیولوژی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه گیلان، رشت، ایران.

2 استاد گروه فیزیولوژی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه گیلان، رشت، ایران.

3 دانشیار بیماری‌های گوارش و کبد بالغین، گروه داخلی، دانشکده پزشکی، مرکز تحقیقات غربالگری و پیشگیری از سرطان‌های گوارش، دانشگاه علوم پزشکی گیلان، رشت، ایران

10.22080/jaep.2021.20718.2012

چکیده

سابقه و هدف: کمبود استروژن به ویژه بتا استرادیول در زمان یائسگی، یکی از دلایل ابتلا به کبد چرب و سندروم متابولیک و پیشرفت آن در زنان یائسه است. همچنین با توجه به تاثیر فعالیت ورزشی و تنظیم کالری دریافتی بر بهبود عوامل خطر ساز این بیماری، در این پژوهش اثر تمرین هوازی و محدودیت کالری بر نیمرخ لیپیدی، استئاتوز کبدی و تغییرات هورمونی در زنان یائسه‌ی مبتلا به کبد چرب غیر الکلی، مورد بررسی قرار گرفت.
مواد و روشها: بیست و چهار زن مبتلا به کبد چرب غیر الکلی نوع به صورت داوطلبانه در این مطالعه شرکت کردند. آزمودنی‌ها‌ به صورت تصادفی به 3 گروه تمرین هوازی، محدودیت کالری و محدودیت کالری همراه با تمرین هوازی یا ترکیبی  تقسیم شدند. در گروه محدودیت کالری، 25 درصد از انرژی مورد نیاز روزانه‌ی هر آزمودنی به مدت 12 هفته کاسته شد. در گروه تمرین هوازی، 25 درصد افزایش هزینه‌ی انرژی از طریق فعالیت ورزشی هوازی در نظر گرفته شد. فعالیت هوازی، به صورت دویدن بر روی نوارگردان بر اساس معادل سوخت و سازی  MET6 (معادل 65 تا 80 درصد ضربان قلب ذخیره)، 4 روز در هفته و به مدت 12 هفته بود. همچنین در گروه ترکیبی، 5/12 درصد افزایش هزینه‌ی انرژی از طریق فعالیت هوازی و 5/12 درصد محدودیت کالری از طریق رژیم کم‌کالری در نظر گرفته شد. سطوح استروژن پلاسمایی و همچنین نیمرخ لیپیدی، انسولین و گلوکز ناشتا در نمونه‌ی سرم، 48 ساعت پیش و پس از تمرین اندازه گیری شد.. اندازه‌گیری چربی کبدی با استفاده از روش الاستوگرافی ناحیه‌ی شکمی ناشتایی انجام شد
یافته ها: پس از 12 هفته میزان سطوح استروژن پلاسمایی و انسولین سرم در گروه‌‌‌‌های محدودیت کالری (به ترتیب %91/7-، %23/19-) و ترکیبی (به ترتیب %03/7-،%65/25-) نسبت به پیش‌آزمون کاهش معناداری داشتند ، اما در گروه تمرین هوازی تغییر معناداری مشاهده نشد. تنها در گروه ترکیبی میزان سطوح کلسترول (%94/7-) و تری‌گلیسرید (%58/9-) نسبت به پیش‌آزمون کاهش معناداری نشان داد(05/0p<). در میزان HDL در هیچ یک از گروه‌ها پس از 12 هفته تغییر معناداری ایجاد نشد. در هر سه گروه تمرین هوازی، محدودیت کالری و ترکیبی نسبت به پیش‌آزمون کاهش معناداری در میزان سطوح LDL (به ترتیب 41%/2-، 54%/1-، 27%/2-)، گلوکز ناشتا (به ترتیب %99/1-، %65/5-، %99/6-)، شاخص مقاومت به انسولین (به ترتیب %32/11-، 38%/23-، 96%/30-)، و استئاتوز کبدی (به ترتیب %50/14-، %22/6-، %90/5-)، مشاهده شد (05/0p<). 
 نتیجه گیری: در مجموع با توجه به بهبود بهبود سطوح LDL، گلوکز، شاخص مقاومت انسولین و استئاتوز کبدی در هر سه گروه پژوهش حاضر، می‌توان نتیجه گرفت که 12 هفته پروتکل تعادل منفی انرژی، روندی موثر در بهبود عوامل مرتبط با بیماری کبد چرب غیر الکلی در زنان یائسه به شمار می‌رود. با این وجود، تمرین هوازی همراه با محدودیت کالری می‌تواند به تغییرات موثرتری در بهبود ترکیب بدن،  نیمرخ لیپیدی و کنترل متابولیکی منجر شود و تمرینات هوازی در حفظ سطح استروژن و بهبود استئاتوز کبدی موثرتر است. لذا با توجه به کاهش سطوح استروژن در نتیجه‌ی تعادل منفی ناشی از محدودیت کالری، همچنین تاثیر توامان فعالیت ورزشی و محدودیت کالری بر بهبود عوامل خطرساز این بیماری، توصیه می‌شود از ترکیب تمرینات هوازی در کنار محدودیت کالری در روند درمان استفاده شود.

کلیدواژه‌ها

عنوان مقاله [English]

Effect of Aerobic Training and Calorie Restriction on Lipid profile, Liver Steatosis and Hormonal Changes in Postmenopausal Women with Non-Alcoholic Fatty-Liver Disease (NAFLD)

نویسندگان [English]

  • Elham Akbarzadeh 1
  • Hamid Mohebbi 2
  • Afshin Shafaghi 3
1 Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
2 Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
3 Department of Internal Medicine, School of Medicine, GI Cancer Screening and Prevention Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
چکیده [English]

Background and Purpose: Estrogen deficiency during menopause is one of the causes of fatty liver and metabolic syndrome and its progression in postmenopausal women. Due to the importance of estrogen reduction during menopause and its relationship with non-alcoholic fatty liver disease, as well as the effect of exercise and calorie restriction on improving the risk factors for this disease, in this study the effect of aerobic training and calorie restriction on lipid profile, liver steatosis and hormonal changes in Postmenopausal Women with Non-Alcoholic Fatty-Liver Disease (NAFLD) was evaluated.
Methodology: Twenty-four women with type 1 non-alcoholic fatty volunteered to participate in this study. The Subjects were randomly divided into 3 groups: aerobic training, calorie restriction and calorie restriction with aerobic training. In the calorie restriction group, 25% of each subject’s daily energy requirement was reduced for 12 weeks. In the aerobic training group, 25% increase in energy expenditure through aerobic exercise was considered. Aerobic training was running on a treadmill based on MET=6 (65% to 80% of the subject’s heart rate reserve) 4 days a week for 12 weeks. Also in the combined group, 12.5% increase in energy expenditure through aerobic exercise and 12.5% calorie restriction through low calorie diet were considered. Plasma levels of estrogen, lipid profile, fasting insulin and glucose 48 hours before and after the training period were measured. Liver fat was measured using abdominal elastography.
Results: After 12 weeks, plasma estrogen and serum insulin levels in the calorie restriction group (-7.91-%, -19.23%, respectively) and combined (-7.03%, -25.65%, respectively) decreased significantly compared to the pretest (p<0.05), But no significant change was observed in the aerobic training group. Only in the combined group, the levels of cholesterol (-7.94%) and triglycerides (-9.58 %) showed a significant decrease compared to the pretest (p<0.05). There was no significant change in HDL levels in any of the groups after 12 weeks. All three groups, aerobic exercise, calorie restriction and combination compared to the pre-test, significantly reduced the LDL levels (-2.41%, -1.54%, -2.27%, respectively), fasting glucose (-1.99%, -5.65, -6.99%, respectively), insulin resistance index (-11.32%, -23.38%, -30.96%, respectively), and hepatic steatosis (-14.50%, -6.22%, -5.90%, respectively) (p <0.05).
Conclusion: In general, considering the improvement of LDL, fasting glucose, insulin resistance index and liver steatosis in all three groups in the present study, it can be concluded that 12 weeks of negative energy balance protocol is an effective process in improving the factors associated with non-alcoholic fatty liver disease in postmenopausal women. However, aerobic exercise combined with calorie restriction can lead to more effective changes in improving body composition, lipid profile, and metabolic control, and aerobic exercise is more effective in maintaining estrogen levels and improving hepatic steatosis. Therefore, according to the background of research and the importance of estrogen reduction during menopause and its relationship with non-alcoholic fatty liver disease and due to the decrease in estrogen levels as a result of negative balance due to calorie restriction, to improve the risk factors for this disease, it is recommended to use a combination of aerobic exercise along with calorie restriction in the treatment process.
 

کلیدواژه‌ها [English]

  • Aerobic Training
  • Calorie Restriction
  • Insulin Resistance
  • NAFLD
  • Postmenopausal Women

مراجع

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  • تاریخ دریافت: 21 دی 1399
  • تاریخ بازنگری: 20 بهمن 1399
  • تاریخ پذیرش: 14 فروردین 1400

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