最大脂肪氧化强度运动和饮食限制对肥胖非酒精性脂肪肝病大学生血脂及铁死亡的影响

Effects of maximum fat oxidation intensity exercise combined with diet restriction on lipid and ferroptosis in obese college students with non-alcoholic fatty liver disease

目的比较12周最大脂肪氧化(FATmax)强度运动结合饮食限制及单独FATmax强度运动对肥胖非酒精性脂肪性肝病(NAFLD)大学生身体成分、脂代谢及铁死亡的影响,为肥胖NAFLD大学生的康复治疗提供运动处方参考。方法于2023年8月,通过网上发布通知和山西医科大学汾阳学院健康体检中心招募在校本科生,从中选取45名肥胖NAFLD大学生,用随机数字表法分为FATmax强度运动结合饮食限制组(FATmax+DR,22名)和FATmax强度运动组(FATmax组,23名)。其中FATmax组进行12周、每周3次的FATmax强度运动(FATmax:0.51 g/min,运动强度:50.14%VO2max,对应的心率:136.78次/min);FATmax+DR组进行12周FATmax强度运动结合饮食限制(每日饮食摄入能量依据静息能耗确定食谱)。干预前后分别对两组受试者身体成分、血脂4项及氧化应激、铁死亡相关指标进行测试。采用独立样本t检验及配对样本t检验分析各组指标差异。结果干预前,FATmax+DR组和FATmax组身体成分、血脂4项及氧化应激、铁死亡相关指标差异均无统计学意义(P值均>0.05)。干预12周后,FATmax+DR组体重、体质量指数(BMI)、体脂肪量、躯干脂肪量、内脏脂肪面积及血清低密度脂蛋白(LDL)、丙二醛(MDA)和铁蛋白水平均低于FATmax组,血清高密度脂蛋白(HDL)及谷胱甘肽(GSH)水平均高于FATmax组(t值分别为-2.30,-3.23,-3.97,-5.85,-3.44,-3.06,-2.03,-2.09;2.73,2.42,P值均<0.05);两组间血清总胆固醇(TC)、甘油三酯(TG)、超氧化物歧化酶(SOD)及谷胱甘肽过氧化物酶4(GPX4)水平差异均无统计学意义(t值分别为1.49,1.00,-0.01,0.59,P值均>0.05)。结论12周FATmax强度运动结合饮食限制在改善肥胖NAFLD大学生身体成分及血脂紊乱、抑制铁死亡发生及肝脏氧化应激损伤方面的效果更加显著。

Objective To compare the effects of 12-week maximum fat oxidation(FATmax)intensity exercise combined with dietary restriction and FATmax intensity exercise alone on body composition,blood lipid metabolism and ferroptosis in obese college students with non-alcoholic fatty liver disease(NAFLD),so as to provide a exercise prescription reference for rehabilitation treatment of obese NAFLD college students.Methods In August 2023,a total of 45 obese NAFLD college students were divided into maximum fat oxidation intensity exercise combined with dietary restriction group(FATmax+DR,n=22)and FATmax group(n=23)by random number table method,who were recruited through online notifications and physical examinations at the Physical Examination Center of Fenyang College of Shanxi Medical University.FATmax group received FATmax intensity exercise with 3 times a week for 12 weeks(FATmax:0.51 g/min,exercise intensity:50.14%VO2max and the heart rate:136.78 times/min).FATmax+DR group underwent 12 weeks of FATmax intensity exercise combined with dietary restriction,and daily dietary energy intake was determined according to resting energy consumption.Body composition,four items of blood lipids and the indicators of oxidative stress and ferroptosis were measured before and after the intervention.The differences of indicators among each group were analyzed by using independent sample t test and paired sample t test.Results Before the intervention,there were no significant differences in body composition,four items of blood lipid,oxidative stress and iron death between FATmax+DR group and FATmax group(P>0.05).After 12 weeks of intervention,body weight,body mass index(BMI),body fat mass,trunk fat mass,visceral fat area and serum low density lipoprotein(LDL)and malondialdehyde(MDA)levels in FATmax+DR group were significantly lower than those in FATmax group,while serum high density lipoprotein(HDL)and glutathione(GSH)levels were higher than those in FATmax group(t=-2.30,-3.23,-3.97,-5.85,-3.44,-3.06,-2.03,-2.09;2.73,2.42,P<0.05).There were no significant differences in serum levels of total cholesterol(TC),triglyceride(TG),superoxide dismutase(SOD)and glutathion peroxidase 4(GPX4)between the two groups(t=1.49,1.00,-0.01,0.59,P>0.05).Conclusion Twelve-week FATmax intensity exercise combined with dietary restriction could significantly improve body composition and dyslipidemia,prevent the occurrence of ferroptosis and liver oxidative damage in obese NAFLD college students,which could serve as a timely promotion and application of intervention for obese college students with NAFLD.