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Lifestyle-Induced Weight Loss Produces Improvement in NASH, Fibrosis
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VIENNA — Weight loss induced through year-long lifestyle intervention independently predicted improvement in non-alcoholic steatohepatitis, non-alcoholic steatosis and fibrosis, according to a study presented at the 2015 International Liver Congress.
“Weight loss induced by a comprehensive lifestyle program during 12 months produces important changes in most of the histological NASH-related features,” Eduardo Vilar-Gomez, MD, from the National Institute of Gastroenterology, Havana, Cuba, said during his presentation. “Our findings support the current recommendation for weight loss lifestyle modification as the first-line therapy for patients with NASH.”
Eduardo Vilar-Gomez
Vilar-Gomez and colleagues analyzed 293 patients introduced to a lifestyle weight loss program over the course of 1 year, with bi-monthly follow-up and liver biopsy at baseline and 52 weeks. They stratified patients into weight loss categories: lost less than 5%, lost 5% to 7%, lost 7% to 10% and lost 10% or more. Multivariable logistic regression models were used to identify association between weight loss and outcomes, adjusted by age, sex, BMI, diabetes status, medication for diabetes or hyperlipidemia and ballooned cells at baseline
At the end of the year-long study, 25% of patients (72/293) obtained NASH resolution; 47% had improvement in nonalcoholic fatty liver disease activity score (NAS) while 48%, 50% and 39% had improved steatosis, lobular inflammation and ballooning, respectively. Just 19% had fibrosis regression, while 15% saw improvement in portal inflammation.
Weight loss was an independent predictor of histological outcomes including resolution of steatohepatitis (OR = 1.62; 95% CI, 1.41-1.87); NAS improvement (OR = 1.48; 95% CI, 1.33-1.64); steatosis improvement (OR = 1.49; 95% CI, 1.34-1.66); lobular inflammation improvement (OR = 1.41; 95% CI, 1.28-1.55); and ballooning improvement (OR = 1.3; 95% CI, 1.2-1.4).
When considered in light of weight loss category, there was a significant difference in NASH resolution with 90% of those with 10% or more weight lost achieving NASH resolution as compared to 64% of those in the 7% to 10% category (P < .001). Similarly, 100% of those who lost 10% or more achieved a two-point improvement in NAS score while just 62% of those in the 5% to 7% category achieved the same (P < .001).
Those in the highest category of weight loss also showed more regression of their fibrosis with 45% regressing and 55% stabilizing. In the secondary category of 7% to 10% weight loss, 16% had fibrosis regression while 84% stabilized. Neither of the highest two categories had any worsening of fibrosis.
“A dose-response relationship is evident among the weight loss and overall histological changes,” Vilar-Gomez said. “Higher rates of steatohepatitis resolution or fibrosis regression were seen in patients with weight loss higher than 10%.” – by Katrina Altersitz
For More Information:
Vilar-Gomez E. Abstract O042. Presented at: International Liver Congress; April 22-26, 2015; Vienna.
Disclosure: Vilar-Gomez reports no relevant financial relationships.