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Weight loss from lifestyle changes associated with improved NASH

Weight loss after changes to diet and exercise routines among patients with nonalcoholic steatohepatitis was associated with an improvement in nonalcoholic steatohepatitis, according to new data published in Gastroenterology.

In a prospective study, 293 patients with NASH from a tertiary medical center in Havana, Cuba, were recommended to make lifestyle changes to reduce their weight between June 2009 and May 2013. Each patient was recommended a low-fat, average-protein diet and encouraged to walk approximately 200 minutes per week, increasing from 90 minutes of moderate exercise to 200 minutes per week over the first 6 months, according to the research. Each patient underwent liver biopsy at baseline and again at the end of 52 weeks to determine any changes in weight and other metabolic and biochemical parameters.  

“The composition of the diets consumed by the subjects and their compliance throughout the study were evaluated through 3-day dietary food records that were completed at baseline and at 8, 16, 24, 32, 40 and 52 weeks,” the researchers wrote.

At the end of 52 weeks, 48% of patients (n = 142) had reductions in nonalcoholic fatty liver disease activity score (NAS), 25% had resolved steatohepatitis (n = 72) and 19% showed signs of regressed fibrosis (n = 56).

Thirty percent of patients at 52 weeks lost at least 5% of their weight (n = 88). The amount of weight loss was independently associated with improved NASH-related histologic parameters (P < .01), according to the analyses.  

More patients who lost at least 5% of their weight had resolved NASH (58% vs. 10%) and a 2-point reduction in NAS (82% vs. 32%) compared with patients who lost less than 5% of their weight (P < .001). In a post-hoc analysis, researchers found that at least a 10% decrease in weight loss was associated with a greater percentage of resolved NASH. Ninety percent of patients who lost at least 10% of their weight experienced resolved NASH and 45% had regressed fibrosis, according to the research.

“All patients who lost 7% [to] 10% of their weight and had few risk factors also had reduced NAS,” the researchers wrote. “In patients with baseline characteristics that included female sex, [BMI greater than or equal to 35], fasting glucose [greater than] 5.5 mmol/L, and many ballooned cells, NAS scores decreased significantly with weight reductions [greater than or equal to] 10%.”

No adverse events related to lifestyle changes were observed over the duration of the study.

The researchers concluded: “The current study shows that weight loss induced by a comprehensive lifestyle program during 12 months produces important changes in most of the histologic NASH-related features. … Our findings support the current recommendation for weight loss using lifestyle modification as the first step in the management of patients with NASH.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.