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Lifestyle intervention leads to NAFLD remission regardless of obesity

Lifestyle intervention was effective in treating nonalcoholic fatty liver disease in both patients with and without obesity, with weight reduction predicting remission of NAFLD in patients without obesity, according to data published in Journal of Hepatology.

“Lifestyle intervention is central in the management of NAFLD,” Vincent Wai-Sun Wong, MD, from the Chinese University of Hong Kong, and colleagues wrote. “A number of diets including low-carbohydrate diet, low-fat diet, low-glycemic index diet and the Mediterranean diet have been shown to improve liver enzyme levels, liver fat, and histology of NAFLD patients. Likewise, beneficial effects have been observed for both aerobic exercise and resistance training.”

Wong and colleagues randomly assigned 77 patients to receive lifestyle intervention and 77 control patients to receive standard care. In each group, 39 patients had a BMI less than 25 kg/m² and 38 patients were obese with a BMI higher than 25 kg/m².

Regarding patients without obesity, the intervention group was significantly more likely to achieve NAFLD remission than the control group (67% vs. 18%; P < .001) and they had a higher mean decline (6.1% vs. 1.3%; P = .001) of intrahepatic triglyceride (IHTG).

Similarly, among patients with obesity, those in the intervention group more likely to achieve NAFLD remission (61% vs. 21%; P < .001) and have a higher mean decline of IHTG (7.4% vs. 2.9%; P = .004), as well as a greater decrease in serum alanine aminotransferase levels and higher likelihood of ALT normalization (58% vs. 26%; P = .005).

Multivariate analysis showed that participation in lifestyle intervention (OR = 5.36; 95% CI, 1.003-28.634), lower baseline IHTG (OR = 0.73; 95% CI, 0.579-0.921) and a decrease in body weight (OR = 0.527; 95% CI, 0.364-0.763) and waist circumference (OR = 0.797; 95% CI, 0.667-0.953) correlated with NAFLD remission among patients without obesity.

Approximately 50% of patients without obesity could achieve NAFLD remission with a 3% to 5% weight reduction, whereas 70% could achieve remission with a reduction of 7% to 10%. Half of the patients with obesity could achieve remission with a weight reduction between 7% and 10%.

In the entire cohort, patients who underwent lifestyle intervention were significantly more likely to achieve weight reduction from month 3 and after, compared with controls. Although the researchers observed rebound in body weight at 1 year, weight reduction remained significantly different between the two groups throughout 6 years of follow-up.

“While our study confirms the short-term efficacy of lifestyle intervention, it is clear that the benefit waned over time after the end of the program,” Wong and colleagues wrote. “This reflects the inherent difficulty in maintaining dietary changes and exercise habits. Nevertheless, our study shows that non-obese patients had less body weight rebound and were able to maintain ALT normalization in 6 years.” – by Talitha Bennett

Disclosure: Wong reports he has served as a consultant or advisory board member for Allergan, Center for Outcomes Research in Liver Diseases, Gilead Sciences, Janssen, Perspectum Diagnostics, Pfizer and TARGET-NASH; and as a speaker for Echosens and Gilead Sciences. Please see the full study for the other authors’ relevant financial disclosures.