Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States. The most advanced forms of NAFLD are associated with increased liver-related mortality and lower overall survival. The current standard of care for NAFLD is lifestyle changes through diet and exercise. The human genome and regulation of gene expression is influenced by physical activity. NAFLD is a prothrombotic state with derangements in all three phases of hemostasis leading to clinically important clotting events. Exercise can improve coagulation in healthy persons. In this proposal, we seek to begin a line of work to answer the question "Can lifestyle changes effectively mitigate the increased risk of clotting in patients with NAFLD?" focusing initially on the at-risk population genetically susceptible to advanced disease.
Name: Aerobic Exercise
Description: The primary outcome of interest is change in fibrinolysis as measured by PAI-1 level immediately following completion of the exercise program.
Measure: PAI-1 level Time: 5 monthsDescription: hemostatic marker
Measure: Change in von williebrand factor (vWF) Time: 5 monthsDescription: hemostatic marker
Measure: change in p-selection Time: 5 monthsDescription: hemostatic marker
Measure: change in protein S Time: 5 monthsDescription: hemostatic marker
Measure: change in factor VIII Time: 5 monthsDescription: hemostatic marker
Measure: change in fibrinogen Time: 5 monthsDescription: hemostatic marker
Measure: change in antithrombin Time: 5 monthsDescription: hemostatic marker
Measure: change in protein C Time: 5 monthsDescription: fibrosis marker
Measure: change in adiponectin Time: 5 monthsDescription: genotyping subjects (GG, GC and CC genotypes)
Measure: Patatin like phospholipase-3 (PNPLA3) rs738409 polymorphism Time: 5 monthsDescription: hemostatic marker
Measure: Change in PAI-1 stratified by PNPLA3 genotype Time: 5 monthsDescription: measured by magnetic resonance imaging proton density fat fractionation (MRI-PDFF)
Measure: change in % hepatic fat Time: 5 monthsDescription: hemostatic markers
Measure: correlation between VO2 max and hemostatic markers Time: 5 monthsDescription: quality of life
Measure: health related quality of life (HRQOL) change Time: 5 monthsDescription: fibrosis
Measure: change in hepatic fibrosis stage Time: 5 monthsAllocation: Randomized
Parallel Assignment
There is one SNP
Patatin like phospholipase-3 (PNPLA3) rs738409 polymorphism.
Patatin like phospholipase-3 (PNPLA3) rs738409 polymorphism (GG, GC and CC genotypes) plays a crucial role in the development of NAFLD.