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Weight loss interventions may improve nonalcoholic fatty liver disease

Weight loss interventions were associated with significant improvements in biomarkers of liver disease in individuals with nonalcoholic fatty liver disease, according to a recent study published in JAMA Internal Medicine.

The results suggest that the recommendation of formal weight loss programs should be added to clinical guidelines and included in regular practice for the treatment of nonalcoholic fatty liver disease (NAFLD), according to the researchers.

“No licensed pharmacotherapy is currently available for NAFLD or [nonalcoholic steatohepatitis]. Clinical guidelines around the world recommend physicians offer advice on lifestyle modification, which mostly includes weight loss through hypoenergetic diets and increased physical activity,” Dimitrios A. Koutoukidis, PhD, of the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and the National Institute for Health Research Oxford Biomedical Research Center at Oxford University Hospitals NHS Foundation Trust, United Kingdom, and colleagues wrote. “However, whether clinicians provide advice and the type of advice they give vary greatly, and guidelines rarely specifically recommend treatment programs to support weight loss.”

Researchers conducted a systematic review and meta-analysis of randomized clinical trials on adults with NAFLD that compared any weight loss interventions, including behavioral interventions, pharmacotherapy and surgery, with no or lower-intensity weight loss interventions. Studies included in analyses reported at least one biomarker of liver disease, such as alanine aminotransferase, aspartate transaminase and alkaline phosphatase. Multiple databases were used to identify trials to include in the study.

After exclusions, 22 studies were included in analyses. Of those, 15 tested behavioral weight loss interventions, six tested pharmacotherapy and one tested a surgical procedure. The median duration of interventions was 6 months. A total of 2,588 participants with a mean age of 45 years were included in analyses.

Weight loss interventions were statistically associated with greater weight change compared with less intensive or no weight loss interventions (–3.61 kg; 95% CI, –5.11 to –2.12).

Weight loss interventions were significantly associated with improvements in biomarkers of liver disease, including alanine amino transferase (–9.81 U/L; 95% CI, –13.12 to –6.5) and histologically or radiologically measured liver steatosis (standardized mean difference = –1.48; 95% CI,–2.27 to –0.7).

Historic NAFLD activity score (–0.92; 95% CI, –1.75 to –0.09) and the presence of nonalcoholic steatohepatitis (OR = 0.14; 95% CI, 0.04-0.49) were also improved with weight loss interventions.

Weight loss interventions did not lead to statistically significant improvements to liver fibrosis.

Researchers noted that 12 of the studies included in the analysis were at high risk for bias, so a separate sensitivity analysis of three trials with a low risk for bias was performed and yielded similar results.

“Overall, this study should encourage clinicians— hepatologists and primary care physicians alike — to incorporate weight loss programs into their treatment of NAFLD,” Elizabeth Adler, MD, of the department of medicine at University of California, San Francisco, and Danielle Brandman, MD, MAS, of the division of gastroenterology in the department of medicine at the University of California, San Francisco, wrote in a commentary published with the study. “In addition, large-scale support for interventions focused on maintenance of weight loss will be key in trying to curb the impending epidemic of advanced liver disease due to NAFLD.” – by Erin Michael

Disclosures: Adler and Koutoukidis report no relevant financial disclosures. Brandman reports research funding from Allergan, Conatus and Gilead. Please see the full study for all other authors’ relevant disclosures.