Aerobic-Resistance Training with Royal Jelly Supplementation Has a Synergistic Effect on Paraoxonase 1 Changes and Liver Function in Women with MASLD.

: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a clinical pathological syndrome characterized by steatosis and fat accumulation in liver parenchymal cells in patients without a history of excessive alcohol drinking. Currently, there is no definitive treatment for MASLD, and its prevalence increases with age and obesity, and after menopause. Among the ways to treat it, we can mention regular sports exercises and the use of natural supplements. Therefore, the aim of this research is to investigate and compare the effects of aerobic-resistance training with royal jelly supplementation on changes in paraoxonase 1, oxidized LDL, liver function, and lipid profile in postmenopausal women with Dysfunction-Associated Steatotic Liver Disease. : This semi-experimental study involved 23 women with Dysfunction-Associated Steatotic Liver Disease with an average weight (71.34 ± 11.63 kg), age (48.54 ± 3.88 years), and body mass index (27.63 ± 4.20 kg/m). They were randomly divided into two groups: exercise + supplement ( = 12) and exercise + placebo ( = 11). Both groups performed eight-station resistance exercises (8-12 repetitions in 2-4 sets) for 8 weeks, with three sessions per week (for 35-40 min, from 10-15 RPE), and then, for 10-15 min of active rest, they performed aerobic exercises with an intensity of 40-85% of the target heart rate, in two-minute intervals with 45 s of active rest. Royal jelly supplement (500 mg on training days, before each training session) was consumed. Blood sampling was done before and 48 h after the last training session. Statistical analysis was performed using a variance test with repeated measures (two groups × two stages of pre-test-post-test) in SPSS software (Version 26) with a significance level of < 0.05. : The results of the statistical analysis show that the effects of eight weeks of exercise + supplement and exercise + placebo on PON1, oxLDL, lipid profiles (HDL, LDL, TC, and TG), and liver enzymes (ALT, AST) in women with non-alcoholic fatty liver showed a significant difference ( < 0.05). The results show a significant increase in PON1 ( = 0.008) and HDL ( = 0.005) in the exercise + supplement group compared to the exercise + placebo group. But significant decreases in oxLDL ( = 0.031), TC ( = 0.045), TG ( = 0.013), LDL ( = 0.027), ALT ( = 0.015) and AST ( = 0.009) were observed in the exercise + supplement group compared to the exercise + placebo group (<0.05). The results show a significant increase in PON1 ( = 0.008) and HDL ( = 0.005) in the exercise + supplement group compared to the exercise + placebo group. However, significant decreases in oxLDL ( = 0.031), TC ( = 0.045), TG ( = 0.013), LDL ( = 0.027), ALT ( = 0.015), and AST ( = 0.009) was observed in the exercise + supplement group compared to the exercise + placebo group. : Based on the results, it can be concluded that aerobic-resistance exercises with the addition of royal jelly can probably be an efficient and recommended strategy to minimize the harmful effects of Dysfunction-Associated Steatotic Liver Disease by affecting the activity of liver enzymes, paraoxonase 1, LDL oxidation, and lipid profile. Although exercise alone also yielded favorable results, according to the findings of this research, it can be said that exercise, combined with the use of royal jelly supplements, may have more positive effects on reducing liver complications and improving body function. However, in order to obtain more accurate scientific evidence, it is necessary to investigate more doses and timing of royal jelly in future studies.