The Effect of Exercise Training on Fetuin-A Levels in Individuals with Metabolic and Kidney Diseases: A Systematic Review with Meta-analysis

Fetuin-A, as a hepatokine, plays an important role in the regulation of whole-body metabolism, which is increased with chronic diseases. Therefore, the aim of this meta-analysis is to investigate the effect of exercise training on Fetuin-A levels in individuals with metabolic and kidney diseases.

A systematic search was conducted in PubMed, Web of Science, and Google Scholar databases until November 2022 using the keywords "exercise training" and "Fetuin-A". To determine the effect size, standardized mean difference (SMD) and 95% confidence interval were calculated using CMA2 software. Heterogeneity was evaluated using the I2 test, and publication bias was evaluated by visual interpretation of the funnel plot and Egger's test. The quality of the included studies was evaluated using the PEDRO checklist.

A total of 16 studies including 21 trials arms and 554 subjects with type 2 diabetes, obesity and kidney disease were included in the meta-analysis. Exercise training resulted in a significant decrease in Fetuin-A levels [-0.93 (CI: -1.35 to -0.51) P= 0.001]. There was a high heterogeneity (I2= 89.24, P= 0.001) and also a significant publication bias (P= 0.001). The results of subgroup analysis based on the type of exercise training showed that aerobic training resulted in a significant decrease in Fetuin-A (P= 0.001) while the reduction of this marker with combined training was not significant (P= 0.33).

Exercise training, especially aerobic training, results in a decrease in Fetuin-A levels in metabolic patients, which may be contributed to the beneficial effects of exercise.