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Obesity in Liver Disease: 6 reports on comorbid overlap

The negative effects of obesity on overall health have been well-established along with the increasing rates throughout both the U.S. and internationally. Obesity as a comorbidity in liver disease can affect progression of nonalcoholic fatty liver disease and compound alcohol-related liver complications. Recent studies have also shown that obesity in liver disease may have a more complex pathophysiology than previously thought.

Healio Gastroenterology and Liver Disease presents the following reports on the overlap of obesity and alcohol in fatty liver, the differing effects of alcohol based on obesity status, and data showing adverse reactions regardless of obesity in NAFLD and nonalcoholic steatohepatitis.

Call to consensus: Fatty liver terms must reflect obesity, alcohol overlap

Fatty liver experts discussed the necessity of revising current common nomenclature of nonalcoholic fatty liver disease and alcoholic fatty liver disease to better reflect clinical phenotype based on growing prevalence and overlapping features of both classifications.

“With the increased global prevalence of fatty liver disease, efforts are underway to further characterize and sub-phenotype the disease as a necessary tool for the design of clinical trials and for patient stratification,” Arun J. Sanyal, MD, from the Virginia Commonwealth University, and colleagues wrote. “Until evidence points to a specific diagnostic test rather than merely exclusion criteria for diagnosis, we are calling for a consensus to develop a more appropriate nomenclature.” READ MORE

NAFLD regardless of obesity marks increased risk for liver, GI cancers

Nonalcoholic fatty liver disease correlated with an approximately 90% higher risk for liver and gastrointestinal cancers compared with patients without fatty liver disease, while the association between obesity without fatty liver disease and cancer was small.

“The prevalence of obesity has more than doubled in the last four decades and as a result, the incidence of nonalcoholic fatty liver disease (NAFLD) has increased substantially,” Alina M. Allen, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “These unique epidemiologic observations reframe our understanding of the association between obesity and cancer risk. There is a continued need for better characterization of excess adiposity, because current measures of obesity, such as BMI, are insufficient and may overlook other potential key contributors to outcomes, based on ectopic fat distribution.” READ MORE

Moderate alcohol intake effects differ based on steatosis status, obesity

Light to moderate alcohol intake correlated with a decreased risk for simple hepatic steatosis in patients without nonalcoholic fatty liver disease, whereas the same consumption in those with nonalcoholic fatty liver disease and those with obesity had an increased risk, according to recently published data.

Yoosoo Chang, MD, PhD, from the Sungkyunkwan University in South Korea, and colleagues wrote that while studies have suggested that modest alcohol intake correlated with a lower risk for NAFLD compared with no alcohol consumption, those studies did not consider fibrosis and other studies have shown a correlation between modest alcohol intake and hepatic steatosis (HS) in patients with established fatty liver disease. READ MORE

Adverse metabolic profile more impactful on NASH than obesity

Adverse metabolic conditions showed a greater impact on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, significant fibrosis, kidney dysfunction and atherogenic profile compared with “healthy” obesity, according to a recently published study.

“Obesity is a strong risk factor for a lot of entities, including NAFLD,” Javier Ampuero, MD, PhD, from the University Hospital Virgen del Rocío in Spain, and colleagues wrote. “However, some obese people do not suffer from the common metabolic disturbances related to obesity, adopting the concept of metabolically healthy obesity (MHO). The concept of MHO could represent an unfavorable type of body fat distribution with a low but relevant subclinical inflammation.” READ MORE

FGF21 protein may predict severity of NASH in obesity, diabetes

Measurement of fibroblast growth factor 21, a protein widely expressed in the liver, may predict the severity of nonalcoholic steatohepatitis in adults with obesity or type 2 diabetes, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

“Plasma fibroblast growth factor 21 (FGF21) correlates with severe steatohepatitis in patients with nonalcoholic steatohepatitis (NASH), and in particular, fibrosis, the most important feature that determines the progression of disease,” Kenneth Cusi, MD, FACP, FACE, professor of medicine and chief of the division of endocrinology, diabetes and metabolism at the University of Florida and Endocrine Today Editorial Board member, said in an interview. “We also saw that, as patients become more insulin resistant in muscle and adipose tissue, they had higher levels of FGF21. This protein could potentially identify those at the highest risk for disease progression.” READ MORE

Bariatric surgery for obesity improves hepatic steatosis

Bariatric surgery with preoperative very low-calorie diet significantly improved hepatic steatosis in patients with obesity regardless of starting weight or overall weight loss, according to magnetic resonance imaging-estimated proton density fat fraction data from a recently published study.

“The results showed a rapid early phase of improvements in liver fat, followed by a phase of continued improvements at a slower pace,” study coauthor B. Dustin Pooler, MD, from the University of Wisconsin School of Medicine, said in a press release. “The changes began with the initiation of the low-calorie diet and occurred in advance of the overall improvements in BMI among the patients.” READ MORE