Document Type : original article
1 Department of Exercise Physiology, Faculty of Sports Sciences, Razi University, Kermanshah, Iran
2 Department of Clinical Biochemistry, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Background and Purpose: Non-alcoholic fatty liver disease is the most common liver disease that is progressing and affects more than a quarter of the world's population. In this regard, researchers believe that exercise and herbal medicines with anti-lipid and antioxidant properties can be beneficial as supplementary therapy. Therefore, the aim of this study was to examine the effects of eight weeks aerobic training and artichoke distillate consumption on liver fat and serum levels of liver enzymes in women with non-alcoholic fatty liver.
Materials and Methods: For this purpose, 24 obese or overweight volunteer women with non-alcoholic fatty liver with the mean age of 39.9±3.8 years, and mean weight of 75.4±12.1 kg, were randomly assigned into three groups of eight subjects: artichoke, aerobic, and control. Subjects in the aerobic group performed three sessions of aerobic exercises per week for eight weeks. The aerobic training program included 30 minutes of running with an intensity of 11 on the Borg scale rating of perceived exertion during the first week. Training duration increased to 45 minutes and the intensity increased to 13 from the fifth week of the aerobic training program, according to the principle of progressive overload. Subjects in the artichoke group received 180cc of the artichoke distillate per day (60cc after each meal). The control group performed no intervention during the study period. Blood sample and ultrasound sonography of the liver were performed 48 hours before and after the intervention to measure serum levels of Alanine Aminotransferase, Aspartate Aminotransferase, lipid profile (total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein), and liver fat.
Results: Results showed that liver fat levels were significantly decreased within the aerobic (P = 0.034) and the artichoke (P = 0.011) groups. However, there was no significant difference between the effectiveness of the aerobic training and artichoke distillate consumption (P = 0.393). Serum levels of Alanine Aminotransferase and Aspartate Aminotransferase had significant decrement within the aerobic group (P = 0.016 and P = 0.028, respectively). The levels of these enzymes had non-significant decrement within the artichoke group (P = 0.080 and P = 0.172, respectively), and significant increments within the control group (P = 0.024 and P = 0.008, respectively). There were no significant changes in the lipid profile within the groups.
Conclusion: Performing three sessions of aerobic training with moderate intensity per week for eight weeks or consumption of 60cc artichoke distillate after each meal could reduce the levels of liver fat in obese or overweight women with non-alcoholic fatty liver. In addition, these patients can use aerobic training to reduce the liver enzymes and the artichoke distillate to prevent the increase of these enzymes. However, artichoke distillate consumption or moderate-intensity aerobic training could not lead to improvement of the liver fat levels in two months, without following a healthy diet regimen or other medical treatments.
- Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.
- Ofosu A, Ramai D, Reddy M. Non-alcoholic fatty liver disease: controlling an emerging epidemic, challenges, and future directions. Annals of gastroenterology. 2018;31(3):288.
- Oligschlaeger Y, Shiri-Sverdlov R. NAFLD preclinical models: more than a handful, less of a concern? Biomedicines. 2020;8(2):28.
- Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta‐analysis. Hepatology. 2011;54(3):1082-90.
- Sookoian S, Pirola CJ. Liver enzymes, metabolomics and genome-wide association studies: from systems biology to the personalized medicine. World Journal of Gastroenterology: WJG. 2015;21(3):711.
- Asada F, Nomura T, Hosui A, Kubota M. Influence of increased physical activity without body weight loss on hepatic inflammation in patients with nonalcoholic fatty liver disease. Environmental Health and Preventive Medicine. 2020;25(1):1-7.
- Golabi P, Locklear CT, Austin P, Afdhal S, Byrns M, Gerber L, et al. Effectiveness of exercise in hepatic fat mobilization in non-alcoholic fatty liver disease: Systematic review. World journal of gastroenterology. 2016;22(27):6318.
- Smart N, King N, McFarlane JR, Graham P, Dieberg G. Effect of exercise training on liver function in adults who are overweight or exhibit fatty liver disease: a systematic review and meta-analysis. British journal of sports medicine. 2018;52(13):834-43.
- van der Windt DJ, Sud V, Zhang H, Tsung A, Huang H. The effects of physical exercise on fatty liver disease. Gene expression. 2018;18(2):89.
- Brown JE, Rice-Evans CA. Luteolin-rich artichoke extract protects low density lipoprotein from oxidation in vitro. Free radical research. 1998;29(3):247-55.
- Englisch W, Beckers C, Unkauf M, Ruepp M, Zinserling V. Efficacy of artichoke dry extract in patients with hyperlipoproteinemia. Arzneimittelforschung. 2000;50(03):260-5.
- Kraft K. Artichoke leaf extract—recent findings reflecting effects on lipid metabolism, liver and gastrointestinal tracts. Phytomedicine. 1997;4(4):369-78.
- Santos HO, Bueno AA, Mota JF. The effect of artichoke on lipid profile: A review of possible mechanisms of action. Pharmacological research. 2018;137:170-8.
- Kollia E, Markaki P, Zoumpoulakis P, Proestos C. Αntioxidant activity of Cynara scolymus L. and Cynara cardunculus L. extracts obtained by different extraction techniques. Natural product research. 2017 May;31(10):1163-7. PubMed PMID: 27687506. Epub 2016/10/01. eng.
- Yilmaz HR, Uz E, Yucel N, Altuntas I, Ozcelik N. Protective effect of caffeic acid phenethyl ester (CAPE) on lipid peroxidation and antioxidant enzymes in diabetic rat liver. Journal of Biochemical and Molecular Toxicology. 2004;18(4):234-8.
- Tolba MF, Omar HA, Azab SS, Khalifa AE, Abdel-Naim AB, Abdel-Rahman SZ. Caffeic acid phenethyl ester: a review of its antioxidant activity, protective effects against ischemia-reperfusion injury and drug adverse reactions. Critical reviews in food science and nutrition. 2016;56(13):2183-90.
- Heidarian E, Rafieian-Kopaei M. Protective effect of artichoke (Cynara scolymus) leaf extract against lead toxicity in rat. Pharmaceutical biology. 2013;51(9):1104-9.
- Tang X, Wei R, Deng A, Lei T. Protective effects of ethanolic extracts from artichoke, an edible herbal medicine, against acute alcohol-induced liver injury in mice. Nutrients. 2017;9(9):1000.
- Pérez-García F, Adzet T, Cañigueral S. Activity of artichoke leaf extract on reactive oxygen species in human leukocytes. Free Radical Research. 2000;33(5):661-5.
- Salem MB, Kolsi RBA, Dhouibi R, Ksouda K, Charfi S, Yaich M, et al. Protective effects of Cynara scolymus leaves extract on metabolic disorders and oxidative stress in alloxan-diabetic rats. BMC complementary and alternative medicine. 2017;17(1):1-19.
- Ben Salem M, Ksouda K, Dhouibi R, Charfi S, Turki M, Hammami S, et al. LC-MS/MS analysis and hepatoprotective activity of artichoke (Cynara Scolymus L.) leaves extract against high fat diet-induced obesity in rats. BioMed research international. 2019;2019.
- Panahi Y, Kianpour P, Mohtashami R, Atkin SL, Butler AE, Jafari R, et al. Efficacy of artichoke leaf extract in non‐alcoholic fatty liver disease: A pilot double‐blind randomized controlled trial. Phytotherapy Research. 2018;32(7):1382-7.
- Rangboo V, Noroozi M, Zavoshy R, Rezadoost SA, Mohammadpoorasl A. The Effect of Artichoke Leaf Extract on Alanine Aminotransferase and Aspartate Aminotransferase in the Patients with Nonalcoholic Steatohepatitis. International Journal of Hepatology. 2016 2016/05/11;2016:4030476.
- Huber R, Müller M, Naumann J, Schenk T, Lüdtke R. Artichoke leave extract for chronic hepatitis C–a pilot study. Phytomedicine. 2009;16(9):801-4.
- Słomko J, Zalewska M, Niemiro W, et al. Evidence-Based Aerobic Exercise Training in Metabolic-Associated Fatty Liver Disease: Systematic Review with Meta-Analysis. J Clin Med. 2021;10(8):1659.
- Machado MV. Aerobic Exercise in the Management of Metabolic Dysfunction Associated Fatty Liver Disease. Diabetes Metab Syndr Obes. 2021;14:3627-3645.
- Roitman JL, La Fontaine T. The Exercise Professional's Guide to Optimizing Health: Strategies for Preventing and Reducing Chronic Disease: Lippincott Williams & Wilkins; 2011.
- Singh D, Das CJ, Baruah MP. Imaging of non alcoholic fatty liver disease: A road less travelled. Indian journal of endocrinology and metabolism. 2013;17(6):990.
- Banaei P, Tadibi V, Rahimi MA. Comparing the effect of concurrent training with and without rest interval on lipid profile and body composition in women with type 2 diabetes. Journal of Sport and Exercise Physiology. 2015;7(1):1045-1050. (In Persian).
- Haghighi AS, Rafieipour A, Hosseini Kakhak SA. The effect of aerobic training and green tea supplementation on some of cardiovascular risk factors in obese men. Journal of Sport and Exercise Physiology. 2011;4(1):565-576. (In Persian).
- Igarashi Y, Akazawa N, Maeda S. Effects of aerobic exercise alone on lipids in healthy east asians: a systematic review and meta-analysis. Journal of atherosclerosis and thrombosis. 2019;26(5):488-503.
- Kodama S, Tanaka S, Saito K, Shu M, Sone Y, Onitake F, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Archives of internal medicine. 2007;167(10):999-1008.