7 recent reports on obesity risks in liver disease, lifestyle intervention

Physicians and researchers have noted the increase in liver disease over the last couple decades, especially nonalcoholic fatty liver disease, correlates significantly with the increase in obesity and overweight. As there are currently no curative options for NAFLD and its progressive form, nonalcoholic steatohepatitis, lifestyle interventions including diet and exercise are key to remission.

Healio presents the following reports on obesity-related risks in fibrosis progression and acute-on-chronic liver failure, the latest research into lifestyle intervention for NAFLD, and outcomes of diet and surgical weight-loss procedures.

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.” Read more

Obesity increases risk for fibrosis progression in fatty liver disease

Obesity and weight gain correlated with an increased risk for fibrosis progression based on aspartate aminotransferase-to-platelet ratio in a large cohort study of adults with nonalcoholic fatty liver disease.

“Weight gain during adulthood is associated with higher leptin and lower adiponectin levels, possibly leading to the development of NASH,” Yejin Kim, MD, from the Kangbuk Samsung Hospital in South Korea, and colleagues wrote. “The protective effect of weight loss against fibrosis progression may relate to fat loss, by which the adverse impacts of excess adiposity may be diminished.” Read more

Morbid obesity increases risk for acute-on-chronic liver failure

Patients with class III obesity have an increased risk for acute-on-chronic liver failure and a higher prevalence of renal failure as a component of ACLF, according to a recently published study.

“We propose that the link between class III obesity and increased risk of ACLF is due to an obesity-related chronic inflammatory state,” Vinay Sundaram, MD, from the Cedars-Sinai Medical Center, California, and colleagues wrote. “Given the high mortality and health care burden associated with obesity, along with its rising prevalence among patients with cirrhosis, we suggest an even greater emphasis on weight reduction among cirrhotic patients with class III obesity.” Read more

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Sleeve gastrectomy with liver transplantation improves outcomes for obesity

Simultaneous liver transplantation and sleeve gastrectomy improved weight loss and led to decreased rates of metabolic complications among obese patients compared with liver transplantation alone, according to recently published data.

“The multidisciplinary management of obese patients with decompensated liver disease before, during and after [liver transplantation (LT)] has become an important challenge,” Daniel Zamora-Valdés, MD, from the Mayo Clinic, Minnesota, and colleagues wrote. “Weight reduction through lifestyle modifications has been shown to benefit obese patients with [nonalcoholic steatohepatitis (NASH)]; however, this is difficult to achieve and sustain, particularly for patients with longstanding, severe medically-complicated obesity (MCO).” Read more

Animal protein linked to NAFLD risk in older, overweight patients

Results of a large population-based study showed that high intake of animal-derived protein correlated with nonalcoholic fatty liver disease among older, overweight Caucasians, independent of well-known risk factors.

“NAFLD is more common in people with an unhealthy lifestyle, that is, with an unhealthy diet and physical inactivity,” Louise J.M. Alferink, MD, from the University Medical Center of Rotterdam in the Netherlands, and colleagues wrote. “Although there are several hundreds of promising pharmacological trials ongoing, there is still no registered drug for the treatment of NAFLD. Therefore, in daily practice, lifestyle modification remains the first-line treatment in NAFLD.” Read more

Call to action: Tailor lifestyle interventions for NAFLD to patients

Lifestyle interventions such as diet and exercise are a critical part of prevention and treatment of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, more so than pharmacotherapy or endoscopic interventions at this moment, according to an expert at Digestive Disease Week 2018.

“My task today is to get everyone reinvigorated about the role of diet and exercise in the treatment of NAFLD and NASH,” Monica Konerman, MD, director of the Michigan Medicine NAFLD Clinic, said during her presentation. “With all of the new trials in pharmacotherapy and the exciting bariatric endoscopic interventions, people don’t tend to get as excited about diet and exercise, but hopefully that will change.” Read more

Web-based lifestyle intervention as effective as group programs for fatty liver

A web-based lifestyle counselling program for patients with nonalcoholic fatty liver disease demonstrated long-term efficacy and non-inferiority compared with group-based lifestyle counselling, according to a presentation at the International Liver Congress 2018.

“Following a structured motivational approach, a web-based interactive intervention, coupled with face-to-face meetings at 6-month intervals, is not less effective than usual lifestyle programs in achieving weight loss, adherence to healthy diet and habitual physical activity, normalization of liver enzymes, without deterioration of surrogate outcomes of fibrosis,” Giulio Marchesini, MD, from the University of Bologna in Italy, said in his presentation. Read more