***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims /hypothesisCardiac disease remains the leading cause of mortality in type 2 diabetes , yet few strategies to target cardiac dysfunction have been developed . This r and omised controlled trial aim ed to investigate high intensity intermittent training ( HIIT ) as a potential therapy to improve cardiac structure and function in type 2 diabetes . The impact of HIIT on liver fat and metabolic control was also investigated . Methods Using an online r and om allocation sequence , 28 patients with type 2 diabetes ( metformin and diet controlled ) were r and omised to 12 weeks of HIIT ( n = 14 ) or st and ard care ( n = 14 ) . Cardiac structure and function were measured by 3.0 T MRI and tagging . Liver fat was determined by 1H-magnetic resonance spectroscopy and glucose control by an OGTT . MRI analysis was performed by an observer blinded to group allocation . All study procedures took place in Newcastle upon Tyne , UK . Results Five patients did not complete the study and were therefore excluded from analysis : this left 12 HIIT and 11 control patients for the intention-to-treat analysis . Compared with controls , HIIT  improved cardiac structure ( left ventricular wall mass 104 ± 17 g to 116 ± 20 g vs 107 ± 25 g to 105 ± 25 g , p < 0.05 ) and systolic function ( stroke volume 76 ± 16 ml to 87 ± 19 ml vs 79 ± 14 ml to 75 ± 15 ml , p < 0.01 ) . Early diastolic filling rates increased ( 241 ± 84 ml/s to 299 ± 89 ml/s vs 250 ± 44 ml/s to 251 ± 47 ml/s , p < 0.05 ) and peak torsion decreased ( 8.1 ± 1.8 ° to 6.9 ± 1.6 ° vs 7.1 ± 2.2 ° to 7.6 ± 1.9 ° , p < 0.05 ) in the treatment group . Following HIIT , there was a 39 % relative reduction in liver fat ( p < 0.05 ) and a reduction in HbA1c ( 7.1 ± 1.0 % [ 54.5 mmol/mol ] to 6.8 ± 0.9 % [ 51.3 mmol/mol ] vs 7.2 ± 0.5 % [ 54.9 mmol/mol ] to 7.4 ± 0.7 % [ 57.0 mmol/mol ] , p < 0.05 ) . Changes in liver fat correlated with changes in HbA1c ( r = 0.70 , p < 0.000 ) and 2 h glucose ( r = 0.57 , p < 0.004 ) . No adverse events were recorded . Conclusions /interpretationThis is the first study to demonstrate improvements in cardiac structure and function , along with the greatest reduction in liver fat , to be recorded following an exercise intervention in type 2 diabetes . HIIT should be considered by clinical care teams as a therapy to improve cardiometabolic risk in patients with type 2 diabetes . Trial registration : www.is rct n.com 78698481 Funding : Medical Research Council BACKGROUND & AIMS We determined the effects of acute and chronic calorie restriction with either a low-fat , high-carbohydrate ( HC ) diet or a low-carbohydrate ( LC ) diet on hepatic and skeletal muscle insulin sensitivity . METHODS Twenty-two obese subjects ( body mass index , 36.5 + /- 0.8 kg/m2 ) were r and omized to an HC ( > 180 g/day ) or LC ( < 50 g/day ) energy-deficit diet . A euglycemic-hyperinsulinemic clamp , muscle biopsy specimens , and magnetic resonance spectroscopy were used to determine insulin action , cellular insulin signaling , and intrahepatic triglyceride ( IHTG ) content before , after 48 hours , and after approximately 11 weeks ( 7 % weight loss ) of diet therapy . RESULTS At 48 hours , IHTG content decreased more in the LC than the HC diet group ( 29.6 % + /- 4.8 % vs 8.9 % + /- 1.4 % ; P < .05 ) but was similar in both groups after 7 % weight loss ( LC diet , 38.0 % + /- 4.5 % ; HC diet , 44.5 % + /- 13.5 % ) . Basal glucose production rate decreased more in the LC than the HC diet group at 48 hours ( 23.4 % + /- 2.2 % vs 7.2 % + /- 1.4 % ; P < .05 ) and after 7 % weight loss ( 20.0 % + /- 2.4 % vs 7.9 % + /- 1.2 % ; P < .05 ) . Insulin-mediated glucose uptake did not change at 48 hours but increased similarly in both groups after 7 % weight loss ( 48.4 % + /- 14.3 % ; P < .05 ) . In both groups , insulin-stimulated phosphorylation of c-Jun-N-terminal kinase decreased by 29 % + /- 13 % and phosphorylation of Akt and insulin receptor substrate 1 increased by 35 % + /- 9 % and 36 % + /- 9 % , respectively , after 7 % weight loss ( all P < .05 ) . CONCLUSIONS Moderate calorie restriction causes temporal changes in liver and skeletal muscle metabolism ; 48 hours of calorie restriction affects the liver ( IHTG content , hepatic insulin sensitivity , and glucose production ) , whereas moderate weight loss affects muscle ( insulin-mediated glucose uptake and insulin signaling ) IMPORTANCE Nonalcoholic fatty liver disease ( NAFLD ) is a prevalent risk factor for chronic liver disease and cardiovascular disease . OBJECTIVE To compare the effects of moderate and vigorous exercise on intrahepatic triglyceride content and metabolic risk factors among patients with NAFLD . DESIGN , SETTING , AND PARTICIPANTS In this r and omized clinical trial , participants with central obesity and NAFLD were recruited from community-based screening in Xiamen , China , from December 1 , 2011 , through December 25 , 2013 . Data analysis was performed from August 28 , 2015 , through December 15 , 2015 . INTERVENTIONS Participants were r and omly assigned to vigorous-moderate exercise ( jogging 150 minutes per week at 65%-80 % of maximum heart rate for 6 months and brisk walking 150 minutes per week at 45%-55 % of maximum heart rate for another 6 months ) , moderate exercise ( brisk walking 150 minutes per week for 12 months ) , or no exercise . MAIN OUTCOMES AND MEASURES Primary outcome , change in intrahepatic triglyceride content measured by proton magnetic resonance spectroscopy at 6 and 12 months ; secondary outcomes , changes in body weight , waist circumference , body fat , and metabolic risk factors . RESULTS A total of 220 individuals ( mean [ SD ] age , 53.9 [ 7.1 ] years ; 149 woman [ 67.7 % ] ) were r and omly assigned to control ( n = 74 ) , moderate exercise ( n = 73 ) , and vigorous-moderate exercise ( n = 73 ) groups . Of them , 211 ( 95.9 % ) completed the 6-month follow-up visit ; 208 ( 94.5 % ) completed the 12-month follow-up visit . Intrahepatic triglyceride content was reduced by 5.0 % ( 95 % CI , -7.2 % to 2.8 % ; P < .001 ) in the vigorous-moderate exercise group and 4.2 % ( 95 % CI , -6.3 % to -2.0 % ; P < .001 ) in the moderate exercise group compared with the control group at the 6-month assessment . It was reduced by 3.9 % ( 95 % CI , -6.0 % to -1.7 % ; P < .001 ) in the vigorous-moderate exercise group and 3.5 % ( 95 % CI , -5.6 % to -1.3 % ; P = .002 ) in the moderate exercise group compared with the control group at the 12-month assessment . Changes in intrahepatic triglyceride content were not significantly different between vigorous-moderate and moderate exercise at the 6- or 12-month assessment . Body weight , waist circumference , and blood pressure were significantly reduced in the vigorous-moderate exercise group compared with the moderate exercise and control groups at the 6-month assessment and in the vigorous-moderate and moderate exercise groups compared with the control group at the 12-month assessment . In addition , body fat was significantly reduced in the vigorous-moderate exercise group compared with the moderate exercise and control groups at the 12-month assessment . After adjusting for weight loss , the net changes in intrahepatic triglyceride content were diminished and became nonsignificant between the exercise and control groups ( except for the moderate exercise group at the 6-month assessment ) . CONCLUSIONS AND RELEVANCE Vigorous and moderate exercise were equally effective in reducing intrahepatic triglyceride content ; the effect appeared to be largely mediated by weight loss . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01418027 BACKGROUND & AIMS Little is known about how weight loss affects magnetic resonance imaging ( MRI ) of liver fat and volume or liver histology in patients with nonalcoholic steatohepatitis ( NASH ) . We measured changes in liver fat and liver volume associated with weight loss by using an advanced MRI method . METHODS We analyzed data collected from a previous r and omized controlled trial in which 43 adult patients with biopsy-proven NASH underwent clinical evaluation , biochemical tests , and MRI and liver biopsy analyses at the start of the study and after 24 weeks . We compared data between  patients who did and did not have at least 5 % decrease in body mass index ( BMI )  during the study period . RESULTS Ten of 43 patients had at least a 5 % decrease in BMI during the study period . These patients had a significant decrease in liver fat , which was based on MRI proton density fat fraction estimates ( 18.3 % ± 7.6 % to 13.6 % ± 13.6 % , P = .03 ) , a relative 25.5 % reduction . They also had a significant decrease in liver volume ( 5.3 % ) . However , no significant changes in levels of alanine aminotransferase or aspartate aminotransferase were observed with weight loss . Thirty-three patients without at least 5 % decrease in BMI had insignificant increases in estimated liver fat fraction and liver volume . CONCLUSIONS A reduction in BMI of at least 5 % is associated with significant decrease in liver fat and volume in patients with biopsy-proven NASH . These data should be considered in assessing effect size in studies of patients with nonalcoholic fatty liver disease or obesity that use MRI-estimated liver fat and volume as end points BACKGROUND & AIMS Aerobic exercise reduces liver fat and visceral adipose tissue ( VAT ) . However , there is limited data from r and omized trials to inform exercise programming recommendations . This study examined the efficacy of commonly prescribed exercise doses for reducing liver fat and VAT using a r and omized placebo-controlled design . METHODS Inactive and overweight/obese adults received 8 weeks of either ; i ) low to moderate intensity , high volume aerobic exercise ( LO : HI , 50 % VO 2peak , 60 min , 4d/week ) ; ii ) high intensity , low volume aerobic exercise ( HI : LO , 70 % VO 2peak , 45 min , 3d/week ) ; iii ) low to moderate intensity , low volume aerobic exercise ( LO : LO , 50 % VO 2peak , 45 min , 3d/week ) ; or iv ) placebo ( PLA ) . Liver fat ( spectroscopy ) and VAT ( magnetic resonance imaging ) were measured before and after intervention . RESULTS Forty-seven of the 48 ( n = 12 in each group ) participants completed the trial . There were no serious adverse events . There was a significant change in group × time interaction in liver fat , which reduced in HI : LO by 2.38 ± 0.73 % , in LO : HI by 2.62 ± 1.00 % , and in LO : LO by 0.84 ± 0.47 % but not in PLA ( increase of 1.10 ± 0.62 % ) ( p = 0.04 ) . There was a significant reduction in VAT in HI : LO ( -258.38 ± 87.78 cm(3 ) ) , in LO : HI ( -386.80 ± 119.5 cm(3 ) ) , and in LO : LO ( -212.96 ± 105 
    Output:
    
Pooling of six studies ( 94 participants ) suggests that exercise training  also improves basal hepatic insulin sensitivity ( mean change in hepatic insulin sensitivity index : 0.13 [ 0.05 to 0.21 ] mg m-2 min-1 per μU mL-1 ) , but available evidence is limited , and the impact of exercise  on insulin-stimulated hepatic insulin sensitivity remains unclear