Hepatic steatosis, the excess storage of intrahepatic lipids, is a rampant clinical problem associated with the obesity epidemic. Hepatic steatosis is linked to increased risk for insulin resistance, type 2 diabetes, and cardiovascular and advanced liver disease. Accumulating evidence shows that physical activity, exercise, and aerobic capacity have profound effects on regulating intrahepatic lipids and mediating susceptibility for hepatic steatosis. Moreover, exercise can effectively reduce hepatic steatosis independent of changes in body mass. In this perspective, we highlight 1) the relationship between obesity and metabolic pathways putatively driving hepatic steatosis compared with changes induced by exercise; 2) the impact of physical activity, exercise, and aerobic capacity compared with caloric restriction on regulating intrahepatic lipids and steatosis risk; 3) the effects of exercise training (modalities, volume, intensity) for treatment of hepatic steatosis, and 4) evidence for a sustained protection against steatosis induced by exercise. Overall, evidence clearly indicates that exercise powerfully regulates intrahepatic storage of fat and risk for steatosis.

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运动对抗肝脂肪变性：潜在机制和临床意义

肝脂肪变性，即肝内脂质的过量储存，是与肥胖流行相关的猖獗的临床问题。肝脏脂肪变性与胰岛素抵抗、2 型糖尿病、心血管疾病和晚期肝病的风险增加有关。越来越多的证据表明，体力活动、运动和有氧能力对调节肝内脂质和介导肝脂肪变性的易感性具有深远的影响。此外，运动可以有效地减少肝脏脂肪变性，而不受体重变化的影响。从这个角度来看，我们强调 1) 与运动引起的变化相比，肥胖与推定导致肝脂肪变性的代谢途径之间的关系；2) 体力活动、锻炼的影响，与热量限制相比，在调节肝内脂质和脂肪变性风险方面的有氧能力；3) 运动训练（方式、训练量、强度）对治疗肝脂肪变性的影响，以及 4) 持续防止运动诱发的脂肪变性的证据。总体而言，证据清楚地表明，运动可以有力地调节肝内脂肪储存和脂肪变性的风险。