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Promote Weight Loss in Patients with NAFLD

Summary and Comment |
September 24, 2013

Promote Weight Loss in Patients with NAFLD

  1. Atif Zaman, MD, MPH

In a community-based intervention, 97% of patients who achieved 10% weight loss also achieved disease remission.

  1. Atif Zaman, MD, MPH

Medical therapy for nonalcoholic fatty liver disease (NAFLD) should include weight loss. In a small randomized, controlled trial, a scripted weight-loss program improved NAFLD (NEJM JW Gastroenterol Mar 12 2010). But can such programs work in community-based settings? To find out, researchers conducted a randomized, controlled superiority trial to assess the efficacy of a community-based lifestyle-modification program in Hong Kong to improve NAFLD.

Patients with NAFLD were defined as having elevated liver enzymes and fatty liver (intrahepatic triglyceride content [IHTG] ≥5% on proton-magnetic resonance spectroscopy). Patients with other liver diseases were excluded. Of 154 patients randomized, 77 participated in the intervention — a 12-week, dietitian-led, lifestyle-modification program held at two urban centers open to the public for the management of obesity and related disorders. Sessions were weekly for the first 4 months and monthly thereafter and focused on ways to reduce caloric intake and increase energy expenditure. The control group received general advice on diet and exercise at a hospital medical clinic. The primary outcome was improvement in fatty liver at 12 months, defined as IHTG <5%.

Based on intention-to-treat analysis, the intervention group had a higher rate of improvement in NAFLD than controls (7% vs. 2%; P<0.001) and lost more weight (5.6 kg vs. 0.6 kg; P<0.001). Notably, of patients who achieved a 10% reduction in weight, 97% achieved remission of NAFLD.

Comment

Data from this well executed study demonstrate not only that a 10% reduction in weight improves nonalcoholic fatty liver disease, but also that a community-based lifestyle-modification program is effective. Although this study was not designed to assess histologic improvement or long-term benefits of such an intervention, weight loss yields many other health benefits. Until other specific therapies are identified for NAFLD, clinicians should continue to look for effective ways to promote weight loss in their patients.

  • Disclosures for Atif Zaman, MD, MPH at time of publication Speaker’s bureau Bristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex

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