Non-alcoholic fatty liver disease (NAFLD) is now the most frequent chronic liver disease that occurs across all age groups and is recognized to occur in 14%-30% of the general population, representing a serious and growing clinical problem due to the growing prevalence of obesity and overweight. Histologically, it resembles alcoholic liver injury but occurs in patients who deny significant alcohol consumption. NAFLD encompasses a spectrum of conditions, ranging from benign hepatocellular steatosis to inflammatory nonalcoholic steatohepatitis, fibrosis, and cirrhosis. The majority of hepatocellular lipids are stored as triglycerides, but other lipid metabolites, such as free fatty acids, cholesterol, and phospholipids, may also be present and play a role in disease progression. NAFLD is associated with obesity and insulin resistance and is considered the hepatic manifestation of the metabolic syndrome, a combination of medical conditions including type 2 diabetes mellitus, hypertension, hyperlipidemia, and visceral adiposity. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies; however, staging the disease requires a liver biopsy. Current treatment relies on weight loss and exercise, although various insulin-sensitizing agents, antioxidants and medications appear promising. The aim of this review is to highlight the current information regarding epidemiology, diagnosis, and management of NAFLD as well as new information about pathogenesis, diagnosis and management of this disease.

BackgroundAging is characterized with immunosenescence associated with a hyper-inflammatory state, characterized by elevated circulating levels of pro-inflammatory mediators. Physical exercise is a potential strategy for improving the immune system dysfunction and chronic inflammation that accompanies aging. However, there is a need to differentiate between aerobic and resistance exercise training regarding human immune system and systemic inflammation among the elderly Saudi population.ObjectiveThe aim of this study was to compare the impact of 6 months of aerobic versus resisted exercise training on inflammatory cytokines and immune system response among elderly.Material and methodsSixty previously sedentary elderly subjects participated in this study, their age ranged from 61–66 years. All Subjects were randomly assigned to supervised aerobic exercise intervention group (group A, n=40) or resistance exercise group (group B, n=40). Number of CD3+,CD4+,CD8+ T cells count and CD4/CD8 ratio were quantified, IL-6, TNF-α and IL10 were measured before and after 6 months, at the end of the study.ResultsThe mean values of CD3+, CD4+ and CD8+ T cells count and IL-10 were significantly increased, whereas the mean values of CD4/CD8 ratio, IL-6 and TNF-α were significantly decreased in group (A) and group (B). Also; there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment.ConclusionThe current study provides evidence that aerobic exercise is more appropriate in modulating the immune system and inflammatory markers among the elderly population.

Background: Alzheimer's disease has a destructive drawbacks on the patient and his/her entire family as this disease badly affects the behavior, cognition and abilities to do activities of daily living (ADL). The physical and mental benefits of exercise are widely known but seldom available to persons suffering from Alzheimer's disease. Objective: The aim of this study was to measure quality of life, systemic inflammation and psychological well-being response to aerobic exercises in Alzheimer's. Methods: Forty Alzheimer elderly subjects were enrolled in two groups; the first group received treadmill aerobic exercise, while the second group was considered as a control group and received no training intervention for two months. Assessment of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), Rosenberg Self-Esteem Scale (RSES),Beck Depression Inventory (BDI), Profile of Mood States(POMS) and SF-36 health quality of life (SF-36 HRQL) were taken before and at the end of the study. Results: There was a 25.2%, 19.4%, 23.5%, 21.3%, 17.7% , 11.7%, 12.5% and 10.1 % reduction in mean values of TNF-α, IL-6, BDI, POMS, health transition SF-36 subscale, bodily pain SF-36 subscale, role functioning: emotional SF-36 subscale and mental health SF-36 subscale respectively in addition to 15.7%, 13.1%, 12.6%, 11.1%, 13.2% and 11.2 % increase in mean values of RSES, physical functioning SF-36 subscale, role functioning:physical SF-36 subscale, general health SF-36 subscale, Vitality SF-36 subscale and Social functioning SF-36 subscale respectively in group (A) received aerobic exercise training, so that there was a significant reduction in the mean values of TNF-α, IL-6, BDI & POMS and increase in the mean values of SF-36 HRQL subscale scores, RSES in group (A) as a result of aerobic exercise training, while the results of group (B) who received no training intervention were not significant. Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study (P<0.05). Conclusion: Treadmill walking exercise training is an effective treatment policy to improve quality of life, systemic inflammation and psychological wellbeing in Alzheimer's.

BackgroundSleep disturbance is a major problem for older adults which can be exacerbated by increased inflammation as aging is associated with increased circulating pro-inflammatory and lower anti-inflammatory cytokines. There is a need to develop alternative medicine techniques to help improve sleep quality in the elderly.ObjectiveTo investigate the effects of aerobic exercise training on the sleep quality and inflammatory cytokines in elderly subjects.Material and methodsForty previously sedentary elderly subjects participated in this study, their age ranged from 61- 67 years. All subjects were randomly assigned to supervised aerobic exercise intervention group (group A, n=25) or control group (group B, n=25). Polysomnographic recordings for sleep quality assessment, interleukin- 6 (IL-6), tumor necrosis factor- alpha (TNF-α) and interleukin-10 (IL-10) were measured before and after 6 months at the end of the study.ResultsThere was a significant increase in total sleep duration, sleep efficiency and sleep onset latency in group(A) after 6 months of aerobic exercise training, while, wake time after sleep onset and rapid eye movement (REM) latency significantly reduced after 6 months of aerobic training compared with values obtained prior to aerobic exercise training. Also, the mean values of TNF- α and IL-6 decreased significantly and the mean value of IL-10 significantly increased in group (A) after the aerobic exercise training, however the results of the control group were not significant. Moreover, there were significant differences between both groups at the end of the study.ConclusionExercise training can be considered as a non-pharmacological modality for modifying sleep quality and inflammation among elderly.

Objective: The incidence of non-alcoholic fatty liver disease (NAFLD) is increasing dramatically affecting up to 30% of the population worldwide. At present, treatment options are limited and pharmacological management of NAFLD has had disappointing results. Some of the best available evidence to improve NAFLD concerns lifestyle modification. Objective: To detect the degree of weight reduction needed to improve the markers of hepatic function and insulin resistance in type-2 diabetics with NAFLD. Methods: One hundred type-2 diabetic male patients with NAFLD were included into this study and divided into two equal groups. Group (A) received aerobic exercise training in addition to diet regimen. Group (B) received no treatment intervention.Results: There was a 26.99%, 40.8%, 33.81%, 32.73%, 37.8% and 15 % reduction in mean values of Alkaline Phosphatase (ALP), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma -Glutamyltransferase (GGT) and Homeostasis Model Assessment-Insulin Resistance-index (HOMA-IR) and BMI respectively in group (A) at the end of the study. While there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment. Conclusion: About 15 % reduction in BMI is effective to improve the liver condition and insulin resistance in type-2 diabetics with NAFLD.

BackgroundType 2 diabetes mellitus is usually related to vascular problems and is associated with impairment in endothelial function characterized by impaired endothelial-dependent vasodilation and increased platelet adhesion. There is limitation in clinical studies that have addressed the beneficial effects of weight reduction in modulating biomarkers of endothelial dysfunction and adipokines dysregulation for obesity associated with type 2 diabetes mellitus.ObjectiveThis study was designed to detect the effects of weight loss on insulin resistance, adhesive molecules and adipokines dysregulation in obese type 2 diabetic patients.MethodsEighty obese patients with type 2 diabetes mellitus, their age ranged from 35–55 years and their body mass index ranged from 31–37 kg/m2 were equally assigned into 2 groups: the weight reduction group received aerobic exercises in addition to diet regimen, where the control group received medical treatment only for 12 weeks.ResultsThere was a 24.04%, 19.33%, 22.78% ,12.28%, 9.35%, 22.53% & 10.12 % reduction in mean values of Homeostasis Model Assessment-Insulin Resistance Index (HOMA-IR), Leptin, Adiponectin, Resistin, intercellular cell adhesion molecule -1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin & body mass index (BMI) respectively in addition to 26.20% & 24.58% increase in the mean values of adiponectin & the quantitative insulin-sensitivity check index (QUICKI) respectively in group (A) at the end of the study. The mean values of leptin, resistin, insulin, HOMA-IR, ICAM-1, VCAM-1, E-selectin & BMI were significantly decreased in addition to significant increase in the mean values of adiponectin & QUICKI in group (A) those that received aerobic exercise training in addition to diet regimen. While the results of group (B) those that received no treatment intervention were not significant. In addition, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment (P<0.05).ConclusionWithin the limit of this study, 10% reduction in body mass index modulates insulin resistance, adhesive molecules and adipokines dysregulation among obese type 2 diabetic patients.

Background: Type 2 diabetes mellitus is associated with abnormal markers of inflammatory cytokines and oxidative stress markers. Although, these abnormalities could be modulated with weight reduction; there is limitation in clinical studies that have addressed the beneficial effects of weight reduction in modulating biomarkers of inflammatory cytokines and oxidative stress for obesity associated with type 2 diabetes mellitus. Objective: This study was designed to detect the effects of weight loss on the inflammatory cytokines, oxidative stress markers in obese type 2 diabetic patients. Material and Methods: Eighty obese patients with type 2 diabetes mellitus, their age ranged from 35-57 years and their body mass index ranged from 31-35 kg/m 2 were equally assigned into 2 groups: the weight reduction group received aerobic exercises, diet regimen, where as the control group received medical treatment only for 12 weeks. Results:The mean values of body mass index (BMI), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (sCRP), conjugated dienes (CD) and malondialdehyde (MDA) were significantly decreased, while the mean values of glutathione peroxidase (GPx), superoxide dismutase (SOD) and glutathione (GSH) were significantly increased in patients of group (A), while changes were not significant in group (B). Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study. Conclusion: Weight loss ameliorates inflammatory cytokines and oxidative stress markers in obese type 2 diabetic patients.

Background: Non-insulin dependent diabetic patients frequently suffer from fatigue symptoms that result from chronic systemic inflammation. Aerobic exercise was proved to modulate systemic inflammation. Objective: This study was an attempt to measure the impact of aerobic exercises on fatigue symptoms related to systemic inflammation in obese patients with type 2 diabetes. Methods: Eighty obese patients with type 2 diabetes participated in the present study, their age ranged from 40-58 years and their BMI ranged from 31-36 kg/m 2 and were assigned to two subgroups; group (A) received aerobic exercise training for 12 weeks and group (B) received no exercise training for 3 months. Measurements of fatigue symptoms and markers of systemic inflammation were assessed before and at the end of the study for all participants in both groups. Results:The mean values of inflammatory markers (IL-6 and TNF-α) and Multidimensional Fatigue Inventory (MFI) was significantly decreased in group (A), while changes were not significant in group (B). Moreover, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study. Sci. 2015;15(4):1142-8. http://dx.doi.org/10.4314/ahs.v15i4.13 Conclusion