{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T10:04:33Z","timestamp":1793613873043,"version":"4.5.0"},"reference-count":49,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T00:00:00Z","timestamp":1665446400000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001231","name":"Victorian Health Promotion Foundation","doi-asserted-by":"publisher","award":["98-0146"],"award-info":[{"award-number":["98-0146"]}],"id":[{"id":"10.13039\/501100001231","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Soroptimist International","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Rotary Club of Kew","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2022,8,31]]},"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Non-alcoholic fatty liver disease (NAFLD) is highly prevalent (~75%) in people with type 2 diabetes (T2D). Since exercise and weight loss (WL) are recommended for the management of both NAFLD and T2D, this study examined whether progressive resistance training (PRT) plus WL could lead to greater improvements in the fatty liver index (FLI), an indicator of NAFLD, compared with WL alone in older adults with T2D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design and methods<\/jats:title>\n                    <jats:p>This study represents a secondary analysis of a 12-month, two-arm randomised controlled trial including 36 overweight and obese adults (60\u201380 years) with T2D randomly allocated to supervised PRT plus WL (hypocaloric diet) (n=19) or WL plus sham (stretching) (n=17) for 6 months (phase I), followed by 6-months home-based training with ad libitum diet (phase II). FLI, which is an algorithm based on waist circumference, body mass index, triglycerides and gamma-glutamyl transferase, was assessed at baseline and every 3 months. Linear mixed models were used to analyse between-group differences over time, adjusting for baseline values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At baseline, the mean\u00b1SD FLI was 76.6\u00b118.5 and the likelihood of NAFLD (FLI &gt;60) in all participants was 86%. Following phase I, both groups had similar statistically significant improvements in FLI (mean change (95% CI): PRT+WL, \u221212 (\u221220 to \u20134); WL, \u22129 (\u221215 to \u20134)), with no significant between-group difference. After the subsequent 6-month home-based phase, the improvements in FLI tended to persist in both groups (PRT+WL, \u22127 (\u221211 to \u20132); WL, \u22124 (\u221210 to 1)), with no between-group differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In older overweight adults with T2D, PRT did not enhance the benefits of WL on FLI, a predictor of NAFLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ACTRN12622000640707.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjdrc-2022-002950","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T12:40:42Z","timestamp":1665492042000},"page":"e002950","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Effect of progressive resistance training with weight loss compared with weight loss alone on the fatty liver index in older adults with type 2 diabetes: secondary analysis of a 12-month randomized controlled trial"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2026-9931","authenticated-orcid":false,"given":"Christine L","family":"Freer","sequence":"first","affiliation":[{"name":"Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena S","family":"George","sequence":"additional","affiliation":[{"name":"Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sze-Yen","family":"Tan","sequence":"additional","affiliation":[{"name":"Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Abbott","sequence":"additional","affiliation":[{"name":"Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"Dunstan","sequence":"additional","affiliation":[{"name":"Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia"},{"name":"Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin M","family":"Daly","sequence":"additional","affiliation":[{"name":"Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,10,11]]},"reference":[{"key":"2025073111544777000_10.5.e002950.1","doi-asserted-by":"crossref","DOI":"10.2991\/jegh.k.191028.001","article-title":"Epidemiology of type 2 diabetes\u2013global burden of disease and forecasted trends","volume":"10","author":"Khan","year":"2020","journal-title":"J Epidemiol Glob Health"},{"key":"2025073111544777000_10.5.e002950.2","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-0614"},{"key":"2025073111544777000_10.5.e002950.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.06.021"},{"key":"2025073111544777000_10.5.e002950.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2016.04.002"},{"key":"2025073111544777000_10.5.e002950.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2016.07.003"},{"key":"2025073111544777000_10.5.e002950.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40842-020-00097-1","article-title":"Nonalcoholic fatty liver disease and type 2 diabetes: where do Diabetologists stand?","volume":"6","author":"Tomah","year":"2020","journal-title":"Clin Diabetes Endocrinol"},{"key":"2025073111544777000_10.5.e002950.7","doi-asserted-by":"crossref","unstructured":"Muzica CM , Sfarti C , Trifan A . Nonalcoholic fatty liver disease and type 2 diabetes mellitus: a bidirectional relationship. Can J Gastroenterol 2020;2020.","DOI":"10.1155\/2020\/6638306"},{"key":"2025073111544777000_10.5.e002950.8","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1016\/j.sjbs.2018.12.016","article-title":"Lifestyle interventions for non-alcoholic fatty liver disease","volume":"26","author":"Ahmed","year":"2019","journal-title":"Saudi J Biol Sci"},{"key":"2025073111544777000_10.5.e002950.9","doi-asserted-by":"crossref","DOI":"10.3390\/diseases5040023","article-title":"An overview of dietary interventions and strategies to optimize the management of non-alcoholic fatty liver disease","volume":"5","author":"Perumpail","year":"2017","journal-title":"Diseases"},{"key":"2025073111544777000_10.5.e002950.10","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.clnu.2018.12.022","article-title":"ESPEN guideline on clinical nutrition in liver disease","volume":"38","author":"Plauth","year":"2019","journal-title":"Clin Nutr"},{"key":"2025073111544777000_10.5.e002950.11","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1007\/s12325-020-01281-6","article-title":"Managing NAFLD in type 2 diabetes: the effect of lifestyle interventions, a narrative review","volume":"37","author":"Parry","year":"2020","journal-title":"Adv Ther"},{"key":"2025073111544777000_10.5.e002950.12","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14514"},{"key":"2025073111544777000_10.5.e002950.13","doi-asserted-by":"crossref","DOI":"10.3390\/nu13010183","article-title":"A narrative review on sarcopenia in type 2 diabetes mellitus: prevalence and associated factors","volume":"13","author":"Izzo","year":"2021","journal-title":"Nutrients"},{"key":"2025073111544777000_10.5.e002950.14","doi-asserted-by":"crossref","unstructured":"Anagnostis P , Gkekas NK , Achilla C . Type 2 diabetes mellitus is associated with increased risk of sarcopenia: a systematic review and meta-analysis. Calcif Tissue Int 2020:1\u201311.","DOI":"10.1007\/s00223-020-00742-y"},{"key":"2025073111544777000_10.5.e002950.15","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1507\/endocrj.EJ16-0124","article-title":"The relationship between hepatic steatosis and skeletal muscle mass index in men with type 2 diabetes","volume":"63","author":"Hashimoto","year":"2016","journal-title":"Endocr J"},{"key":"2025073111544777000_10.5.e002950.16","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-2310"},{"key":"2025073111544777000_10.5.e002950.17","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12072-019-09964-1","article-title":"Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: a systematic review and meta-analysis","volume":"14","author":"Cai","year":"2020","journal-title":"Hepatol Int"},{"key":"2025073111544777000_10.5.e002950.18","doi-asserted-by":"crossref","unstructured":"Liu Y , Ye W , Chen Q . Resistance exercise intensity is correlated with attenuation of HbA1c and insulin in patients with type 2 diabetes: a systematic review and meta-analysis. Int J Env Res Public Health 2019;16.","DOI":"10.3390\/ijerph16010140"},{"key":"2025073111544777000_10.5.e002950.19","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26393"},{"key":"2025073111544777000_10.5.e002950.20","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.diabres.2015.05.033","article-title":"Volume-Dependent effect of supervised exercise training on fatty liver and visceral adiposity index in subjects with type 2 diabetes the Italian diabetes exercise study (ides)","volume":"109","author":"Balducci","year":"2015","journal-title":"Diabetes Res Clin Pract"},{"key":"2025073111544777000_10.5.e002950.21","doi-asserted-by":"crossref","DOI":"10.3390\/nu10040423","article-title":"Resistance training prevents muscle loss induced by caloric restriction in obese elderly individuals: a systematic review and meta-analysis","volume":"10","author":"Sardeli","year":"2018","journal-title":"Nutrients"},{"key":"2025073111544777000_10.5.e002950.22","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.10.1729"},{"key":"2025073111544777000_10.5.e002950.23","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.1.3"},{"key":"2025073111544777000_10.5.e002950.24","unstructured":"Medicine ACoS . ACSM\u2019s guidelines for exercise testing and prescription. Lippincott Williams & Wilkins, 2013."},{"key":"2025073111544777000_10.5.e002950.25","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1471-230X-6-33","article-title":"The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population","volume":"6","author":"Bedogni","year":"2006","journal-title":"J BMC Gastroenterol"},{"key":"2025073111544777000_10.5.e002950.26","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/oxfordjournals.aje.a113987","article-title":"Physical activity assessment methodology in the Five-City project","volume":"121","author":"Sallis","year":"1985","journal-title":"A J Epidemiol"},{"key":"2025073111544777000_10.5.e002950.27","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2011.242073"},{"key":"2025073111544777000_10.5.e002950.28","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-018-0104-9"},{"key":"2025073111544777000_10.5.e002950.29","doi-asserted-by":"crossref","unstructured":"Takahashi A , Imaizumi H , Hayashi M . Simple resistance exercise for 24 weeks decreases alanine aminotransferase levels in patients with non-alcoholic fatty liver disease 2017;1:E2.","DOI":"10.1055\/s-0042-117875"},{"key":"2025073111544777000_10.5.e002950.30","doi-asserted-by":"crossref","unstructured":"Oh S , So R , Shida T . High-Intensity aerobic exercise improves both hepatic fat content and stiffness in sedentary obese men with nonalcoholic fatty liver disease 2017;7:1\u201312.","DOI":"10.1038\/srep43029"},{"key":"2025073111544777000_10.5.e002950.31","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00291.2011"},{"key":"2025073111544777000_10.5.e002950.32","doi-asserted-by":"crossref","unstructured":"Hallsworth K , Thoma C , Hollingsworth KG . Modified high-intensity interval training reduces liver fat and improves cardiac function in non-alcoholic fatty liver disease: a randomized controlled trial 2015;129:1097\u2013105.","DOI":"10.1042\/CS20150308"},{"key":"2025073111544777000_10.5.e002950.33","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3109\/13697137.2012.662251","article-title":"Effect of exercise training and isoflavones on hepatic steatosis in overweight postmenopausal women","volume":"16","author":"Barsalani","year":"2013","journal-title":"Climacteric : the Journal of the International Menopause Society"},{"key":"2025073111544777000_10.5.e002950.34","doi-asserted-by":"crossref","unstructured":"Banitalebi E , Faramarzi M , Nasiri S . Effects of different exercise modalities on novel hepatic steatosis indices in overweight women with type 2 diabetes 2019;25:294.","DOI":"10.3350\/cmh.2018.0086"},{"key":"2025073111544777000_10.5.e002950.35","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23129"},{"key":"2025073111544777000_10.5.e002950.36","doi-asserted-by":"crossref","first-page":"278","DOI":"10.4093\/dmj.2013.37.4.278","article-title":"The role of skeletal muscle in development of nonalcoholic fatty liver disease","volume":"37","author":"Moon","year":"2013","journal-title":"Diabetes Metab J"},{"key":"2025073111544777000_10.5.e002950.37","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30049"},{"key":"2025073111544777000_10.5.e002950.38","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jhep.2016.08.023","article-title":"Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: a systematic review","volume":"66","author":"Hashida","year":"2017","journal-title":"J Hepatol"},{"key":"2025073111544777000_10.5.e002950.39","doi-asserted-by":"publisher","DOI":"10.1111\/sms.12536"},{"key":"2025073111544777000_10.5.e002950.40","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1080\/02640414.2016.1210197","article-title":"Dose-Response relationship between Weekly resistance training volume and increases in muscle mass: a systematic review and meta-analysis","volume":"35","author":"Schoenfeld","year":"2017","journal-title":"J Sports Sci"},{"key":"2025073111544777000_10.5.e002950.41","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.110.007674"},{"key":"2025073111544777000_10.5.e002950.42","doi-asserted-by":"crossref","unstructured":"Haufe S , Engeli S , Kast P . Randomized comparison of reduced fat and reduced carbohydrate hypocaloric diets on intrahepatic fat in overweight and obese human subjects 2011;53:1504\u201314.","DOI":"10.1002\/hep.24242"},{"key":"2025073111544777000_10.5.e002950.43","doi-asserted-by":"crossref","unstructured":"Steven S , Hollingsworth KG , Al-Mrabeh A . Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders 2016;39:808\u201315.","DOI":"10.2337\/dc15-1942"},{"key":"2025073111544777000_10.5.e002950.44","doi-asserted-by":"publisher","DOI":"10.1381\/096089206777346682"},{"key":"2025073111544777000_10.5.e002950.45","doi-asserted-by":"crossref","unstructured":"Vilar-Gomez E , Martinez-Perez Y , Calzadilla-Bertot L . Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis 2015;149:367\u201378.","DOI":"10.1053\/j.gastro.2015.04.005"},{"key":"2025073111544777000_10.5.e002950.46","doi-asserted-by":"crossref","unstructured":"Marin-Alejandre BA , Abete I , Cantero I . The metabolic and hepatic impact of two personalized dietary strategies in subjects with obesity and nonalcoholic fatty liver disease: the fatty liver in obesity (FLiO) randomized controlled trial. Nutrients 2019;11.","DOI":"10.3390\/nu11102543"},{"key":"2025073111544777000_10.5.e002950.47","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.07.013"},{"key":"2025073111544777000_10.5.e002950.48","doi-asserted-by":"crossref","unstructured":"Marin\u2010Alejandre BA , Cantero I , Perez\u2010Diaz\u2010del\u2010Campo N . Effects of two personalized dietary strategies during a 2\u2010year intervention in subjects with nonalcoholic fatty liver disease: a randomized trial 2021.","DOI":"10.1111\/liv.14818"},{"key":"2025073111544777000_10.5.e002950.49","unstructured":"Pasco JA , Sui SX , West EC . Fatty liver index and skeletal muscle density 2022:1\u20139."}],"container-title":["BMJ Open Diabetes Research &amp; Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjdrc-2022-002950","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T18:54:56Z","timestamp":1753988096000},"score":1,"resource":{"primary":{"URL":"https:\/\/drc.bmj.com\/lookup\/doi\/10.1136\/bmjdrc-2022-002950"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,10,11]]},"published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1136\/bmjdrc-2022-002950"],"URL":"https:\/\/doi.org\/10.1136\/bmjdrc-2022-002950","relation":{},"ISSN":["2052-4897"],"issn-type":[{"value":"2052-4897","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10]]}}}