The advantages of physical exercise as a preventive strategy against NAFLD in postmenopausal women

Abstract

Background The prevalence and severity of nonalcoholic fatty liver disease (NAFLD) increase in women after menopause. This narrative review discusses the causes and consequences of NAFLD in postmenopausal women and describes how physical activity can contribute to its prevention. Methods The authors followed the narrative review method to perform a critical and objective analysis of the current knowledge on the topic. The Medical Subject Heading keywords ‘physical exercise’, ‘menopause’, ‘hormone replacement therapy’, ‘estradiol’ and ‘NAFLD’ were used to establish a conceptual framework. The databases used to collect relevant references included Medline and specialized high‐impact journals. Results Higher visceral adiposity, higher rate of lipolysis in adipose tissue after oestrogen drop and changes in the expression of housekeeping proteins involved in hepatic lipid management are observed in women after menopause, contributing to NAFLD. Excessive liver steatosis leads to hepatic insulin resistance, oxidative stress and inflammation, accelerating NAFLD progression. Physical activity brings beneficial effects against several postmenopausal‐associated complications, including NAFLD progression. Aerobic and resistance exercises partially counteract alterations induced by metabolic syndrome in sedentary postmenopausal women, impacting NAFLD progression and severity. Conclusions With the increased global obesity epidemic in developing countries, NAFLD is becoming a severe problem with increased prevalence in women after menopause. Evidence shows that physical activity may delay NAFLD development and severity in postmenopausal women, although the prescription of age‐appropriate physical activity programmes is advisable to assure the health benefits.

Metabolic Disorders in Menopause

“…Visceral fat accumulation is one of the characteristics of FLD. Overweight, obesity, dyslipidemia, insulin resistance, type 2 DM, and sedentary behavior accompanied by lack of physical activity, which are closely related to factors of MetS, are the major causes of the increasing trend of NAFLD/MAFLD worldwide [ 60 ]. Therefore, in postmenopausal women, the rate of progression of NAFLD/MAFLD and the severity of the disease increase.…”

“…This is when obesity increases due to changes in lipid transport and lipid metabolism, and the distribution of fat from the subcutaneous to visceral adipose tissue changes, which increases the severity of NAFLD/MAFLD in postmenopausal women. Additionally, when estradiol-mediated gene expression of enzymes involved in lipid metabolism increases NAFLD/MAFLD susceptibility in postmenopausal women, they become more susceptible to NAFLD/MAFLD [ 59 , 60 ].…”

“…In postmenopausal women, higher visceral fat is accumulated due to changes in metabolism and body composition, and adipose tissue is more lipolytic after estrogen reduction [ 23 , 60 ]. In addition, expression of housekeeping proteins related with the management of hepatic lipid is altered, contributing to the pathogenesis of NAFLD.…”

“…In addition, expression of housekeeping proteins related with the management of hepatic lipid is altered, contributing to the pathogenesis of NAFLD. Excessive hepatic steatosis accelerates NAFLD progression by causing hepatic insulin resistance, oxidative stress, and inflammation [ 60 ].…”

Dose–Response Relationship of Resistance Training on Metabolic Phenotypes, Body Composition and Lipid Profile in Menopausal Women

“…Regarding the practice of physical activity, it has been observed that different modalities, intensities and volumes of training can result in cardiometabolic improvement and prevention of the MUH phenotype [ 6 , 7 ]. Martinéz-Goméz et al [ 8 ], in a cohort study with individuals of both sexes and different BMI classes, identified an inverse association between the practice of leisure-time physical activity and the incidence of the MUH phenotype among those with MH normal weight and overweight.…”