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Iron depletion linked to improved liver damage among NAFLD patients
Iron depletion by phlebotomy improved overall liver damage among patients with nonalcoholic fatty liver disease, compared with those who made only lifestyle changes, according to recent study data.
Luca Valenti, MD, assistant professor, department of internal medicine, University of Milan, Italy, and colleagues conducted a randomized, phase 3 trial with 38 patients with nonalcoholic fatty liver disease (NAFLD) who had made at least 6 months of lifestyle changes. Liver biopsies to detect steatosis and hyperferritinemia were conducted on all patients between January 2007 and December 2010, and patients were assigned phlebotomy to acquire iron depletion (n=21) or continued to make lifestyle changes and attend counseling (n=17). The primary outcome was reduced liver damage based on NAFLD activity score at 2 years.
Luca Valenti
Patients (89.4% men) were mostly middle-aged and overweight and were evaluated during a 24-month period. Among the phlebotomy group, 350 cc blood was drawn from each patient every 10 to 15 days until transferrin saturation was less than 25% or until ferritin levels dropped below 30 ng/mL indicating iron depletion. The median number of phlebotomies to reach iron depletion was 16.
Researchers observed greater overall histological improvement in the iron-depleted patients compared with the lifestyle group (67% vs. 22%; P=.039). Iron-depleted patients also showed more improvement in steatosis grade (P=.02). At 2-year follow-up, aspartate aminotransferase, alanine aminotransferase (ALT) and gamma-glutamyl-transferase levels were lower in the iron depleted group vs. the lifestyle group (P<.05 for all) among 35 evaluable patients.
Patients in the phlebotomy group also showed greater improvement in histological damage or ALT decreases of at least 20%, when biopsies were not taken, than controls (P=.022)
“Present and previous results suggest that, in the absence of pharmacological treatments, larger trials evaluating phlebotomy treatment may be conducted in patients with severe NAFLD and hyperferritinemia resistant to lifestyle changes,” researchers said.
Disclosure: Valenti reports no relevant financial disclosures.