Diet, exercise reduced HVPG in obese patients with cirrhosis and portal hypertension

BOSTON — In obese patients with cirrhosis and portal hypertension, a 16-week diet and moderate exercise intervention safely reduced hepatic vein pressure gradients, or HVPG, in addition to body weight, according to data presented at a plenary presentation at The Liver Meeting.

“We hypothesized that obesity related factors … might lead to an increase in portal pressure over time, and therefore weight loss would be able to improve these factors and reduce portal pressure,” Annalisa Berzigotti, MD, from the Hospital Clinic in Provincial and CIBERehd in Spain, said in a presentation. “Therefore we designed the present … study to test whether in overweight or obese patients with cirrhosis and portal hypertension weight loss is associated with a reduction in HVPG, which was our primary endpoint, whether the beneficial effect on HVPG is more evident in patients who achieved greater weight loss, and we hypothesized that a 16-week intensive lifestyle intervention … would be able to induce weight loss in this population.”

Annalisa Berzigotti

In this prospective, multicenter pilot study (the SportDiet study) 50 obese cirrhosis patients (aged 56±8 years; 62% men) completed a 16-week program that included a nutritionist-supervised hypocaloric diet (20-25% protein content) plus 60 minutes of supervised exercise per week. Cirrhosis etiologies included 36% viral, 38% alcoholic and 26% NASH. Average BMI was 33.3±3.2 kg/m², 92% were Child A, 72% had at least 10 mmHg HVPG, 30% had previous variceal hemorrhage, 62% had esophageal varices (EV) and 60% were on non-selective beta-blockers.

The intervention decreased body weight by a mean of –5±4 kg (median –5.2%; range, –15% to 3.1%; P<.0001), which was associated with significant reductions in waist circumference and body fat mass; 52% of patients had at least 5% reduction in body weight and 16% had at least 10% reduction. HVPG decreased from 13.9±5.6 mmHg to 12.3±5.2 mmHg (P<.0001), with an average reduction of –10.7±17.9%, and 42% of patients having at least 10% HVPG reduction and 24% having at least 20% reduction. In four patients with weight loss of at least 5% HVPG dropped below 10 mmHg. Patients with weight loss of at least 10% had greater reductions in HVPG compared with patients who had weight loss less than 10% (–23.7±19.9% vs. –8.2±16.6%; P=.024), and patients with diabetes had less weight and HVPG reduction. These patterns were comparable irrespective of etiologies of cirrhosis, portal hypertension and EV, treatment with NSBB, history of variceal bleeding and study center. There were no clinical decompensation episodes, no changes in Child and MELD scores and weight loss remained stable (84.8 Kg at 6 months vs. 85.7 Kg 16 weeks after intervention; P=.136).

“According to our data we consider that an intensive 16-week program of tailored diet and moderate exercise can be safely recommended to obtain weight loss and HVPG decrease in overweight, obese patients with compensated cirrhosis and portal hypertension, and we feel that this fits the concept of value based medicine,” Berzigotti said. “Further research is of course needed to ascertain the mechanism explaining the effects of diet and exercise on portal hypertension in cirrhosis.” – by Adam Leitenberger

For more information:

Berzigotti A. Abstract 110. Presented at: The Liver Meeting, Nov. 7-11, 2014; Boston, MA.

Disclosure: See the abstract for a full list of relevant financial disclosures.