Gastroenterology

Gastroenterology

Volume 149, Issue 2, August 2015, Pages 367-378.e5
Gastroenterology

Original Research
Full Report: Clinical—Liver
Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis

https://doi.org/10.1053/j.gastro.2015.04.005Get rights and content

Background & Aims

It is not clear how weight loss affects histologic features of liver in patients with nonalcoholic steatohepatitis (NASH). We examined the association between the magnitude of weight loss through lifestyle modifications and changes in histologic features of NASH.

Methods

We conducted a prospective study of 293 patients with histologically proven NASH who were encouraged to adopt recommended lifestyle changes to reduce their weight over 52 weeks, from June 2009 through May 2013, at a tertiary medical center in Havana, Cuba. Liver biopsies were collected when the study began and at week 52 of the diet and were analyzed histologically.

Results

Paired liver biopsies were available from 261 patients. Among 293 patients who underwent lifestyle changes for 52 weeks, 72 (25%) achieved resolution of steatohepatitis, 138 (47%) had reductions in nonalcoholic fatty liver disease activity score (NAS), and 56 (19%) had regression of fibrosis. At week fifty-two, 88 subjects (30%) had lost ≥5% of their weight. Degree of weight loss was independently associated with improvements in all NASH-related histologic parameters (odds ratios = 1.1−2.0; P < .01). A higher proportion of subjects with ≥5% weight loss had NASH resolution (51 of 88 [58%]) and a 2-point reduction in NAS (72 of 88 [82%]) than subjects who lost <5% of their weight (P < .001). All patients who lost ≥10% of their weight had reductions NAS, 90% had resolution of NASH, and 45% had regression of fibrosis. All patients who lost 7%−10% of their weight and had few risk factors also had reduced NAS. In patients with baseline characteristics that included female sex, body mass index ≥35, fasting glucose >5.5 mmol/L, and many ballooned cells, NAS scores decreased significantly with weight reductions ≥10%.

Conclusions

A greater extent of weight loss, induced by lifestyle changes, is associated with the level of improvement in histologic features of NASH. The highest rates of NAS reduction, NASH resolution, and fibrosis regression occurred in patients with weight losses ≥10%.

Section snippets

Design

This was a prospective inception cohort “noninterventional” study22, 23 focusing on patients with histologic diagnosis of NASH who started a course of lifestyle modification for 12 months in routine clinical practice. Study follow-up for outcomes began at precisely the same time as initiation of lifestyle intervention. Patients were prospectively and consecutively enrolled in the study after accepting the recommended lifestyle changes plan and fulfilling the selection criteria.

Participants

From June 2009 to

Baseline Characteristic of Participants

Of 349 participants invited to the lifestyle intervention program, 337 agreed and 12 declined. Among those patients who agreed, 44 did not meet our eligibility criteria and were excluded from the study. Thus, a total of 293 subjects were included. During the follow-up, 261 (89%) underwent paired liver biopsies, 24 were lost, and 8 declined to participate in a second liver biopsy (Figure 1). Overall, the mean age of patients was 48.5 years, with a predominance of women (59%). The mean BMI was

Discussion

Although diet and an increased physical activity are well-established therapeutic strategies for conditions such as diabetes and cardiovascular disease, little evidence exists for providing a similar recommendation for NAFLD.35, 36, 37, 38

To the best of our knowledge, this is the first large prospective study conducted in real-world clinical practice that explores the potential benefit of a 12-month of lifestyle intervention on histologic NASH-related features. To date, only a few studies have

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    This article has an accompanying continuing medical education activity on page e14. Learning Objective: Upon completion of this CME exam, successful learners will be able to identify associations between different degrees of weight loss induced by lifestyle modifications during 52 weeks and improvements in NASH-related histological outcomes, that will help establish a personalized disease management strategy based on weight-loss goals and patient characteristics in clinical practice.

    Conflicts of interest The authors disclose no conflicts.

    Funding This work was supported in part by the National Institute of Gastroenterology and Ministry of Health (grant ING-CITMA-2009).

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