Weight Loss Works for Nonalcoholic Steatohepatitis

August 12, 2015

Weight Loss Works for Nonalcoholic Steatohepatitis

  1. Atif Zaman, MD, MPH

Even a 5% loss in body-mass index can improve NASH, though the more weight loss the better.

  1. Atif Zaman, MD, MPH

Weight loss is recommended by most clinicians for treatment of nonalcoholic steatohepatitis (NASH), though evidence supporting this approach is limited. In two prospective studies, researchers assessed the efficacy of lifestyle modification and surgery in achieving weight loss in this population.

In the first study, 293 patients with histologically proven NASH adopted a low-fat, hypocaloric diet, walked 200 minutes weekly, and attended individual behavioral sessions to promote diet adherence. Based on biopsy samples taken at baseline and week 52, NASH resolved in 25% of patients, the nonalcoholic fatty liver disease activity score decreased in 47%, and 19% experienced regression of fibrosis. The degree of weight loss was independently associated with histologic improvement of NASH. Patients with ≥5% weight loss had significantly greater histologic improvement of NASH compared with patients with <5% weight loss. In patients with ≥10% weight loss, NASH was resolved in 90% and regression of fibrosis in 45%.

In a second study of 109 patients with severe or morbid obesity and biopsy-proven NASH who underwent bariatric surgery, at 1 year postsurgery, body-mass index (BMI) was significantly reduced (from 49 to 37 kg/m2), NASH was resolved in 85%, and fibrosis was reduced in 34%. Patients with unresolved NASH experienced a lower mean decrease in BMI (9 vs. 12 kg/m2) and were more likely to have refractory insulin resistance profile (67% vs. 21%).

Comment

These data confirm that weight loss, even as little as 5%, can improve NASH. Greater weight loss appears to lead to greater histologic improvement. Lifestyle modification or bariatric surgery seems to be effective, though in these studies, only about 10% of participants pursuing lifestyle modification achieved ≥10% weight loss, and long-term durability of weight loss was not assessed. Clinicians can now confidently counsel patients with NASH regarding the effectiveness of weight loss. Future drug therapies for NASH will likely be adjunctive to weight-loss interventions.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose

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