Losing weight can be especially challenging for people with fatty liver disease due to metabolic differences, but it is achievable and can significantly improve liver health. This was the key takeaway from studies presented at the AASLD Liver Meeting in Boston.
The Growing Burden of NAFLD and NASH
- Non-alcoholic fatty liver disease (NAFLD) and its severe form, non-alcoholic steatohepatitis (NASH), are increasing causes of advanced liver disease worldwide.
- Obesity and metabolic syndrome are closely linked to NAFLD/NASH, driving its prevalence as global obesity rates rise.
- Consequences of NAFLD/NASH include:
- Fibrosis and cirrhosis.
- Liver cancer.
- Potential need for liver transplantation.
Study on Weight Loss Interventions
Australian Retrospective Cohort Study
- Conducted at St Vincent’s Hospital, Melbourne (July 2015 – February 2019).
- Participants:
- 211 obese individuals, 113 with NAFLD (FLI ≥ 60).
- Median age: 48 years.
- NAFLD group:
- 42% male.
- 43% with type 2 diabetes.
- More likely to have childhood obesity (52% vs. 33%).
- Less physically active (18% vs. 34%).
- Intervention:
- Very low energy diet (VLED), 800 calories/day for 12 weeks.
- Allowed one small meal/day for adherence.
- Designed to induce ketosis, increasing satiety and reducing hunger.
Results:
- Three-Month Outcomes:
- 49% of NAFLD participants achieved ≥5% weight loss.
- NAFLD group lost 4.9% total body weight compared to 7.6% in the non-NAFLD group.
- Six-Month Outcomes:
- 61% of NAFLD participants achieved ≥5% weight loss.
- NAFLD group lost 9.0% body weight versus 11.3% in non-NAFLD participants.
- Differences between groups were no longer statistically significant.
- Predictors of Weight Loss:
- FLI ≥ 60 was the only independent predictor of not achieving ≥5% weight loss.
Additional Insights:
- Many participants reported improved energy levels and quality of life, suggesting psychological benefits beyond physical health.
- Compliance was influenced by factors such as support systems, access to diet resources, and initial motivation levels.
Real-World Weight Loss Outcomes
TARGET-NASH Observational Study
- Participants:
- 2,037 overweight or obese individuals with NAFLD.
- Median age: 55 years.
- 70% white, 13% Latino.
- One-third classified as overweight (BMI 25-30), class I obesity (BMI 30-35), or class II/III obesity (BMI > 35).
- Exclusions:
- Decompensated cirrhosis, cancer, bariatric surgery, or weight loss medications.
Findings:
- Weight Loss Achievements:
- 32% lost weight, with 34% achieving ≥5% weight loss.
- 33% lost ≥7% body weight; 10% achieved ≥10% weight loss.
- Median time to reach 5% weight loss: 17.6 months.
- Factors Influencing Weight Loss:
- Class II/III obesity, diabetes, cardiovascular disease, and cirrhosis increased likelihood of weight loss.
- Nutritional counseling and exercise recommendations were rare but effective when provided.
- Regain Rates:
- 20% regained weight to baseline levels within 24-31 months.
- Geographical Differences:
- Patients treated in academic centers showed slightly higher success rates compared to those in community clinics, likely due to access to specialized care.
Impacts on Liver Health:
- Weight loss, even modest, was linked to improved liver enzyme levels (ALT reduction), suggesting decreased liver inflammation.
- Long-term follow-up indicated potential stabilization of fibrosis progression in patients achieving sustained weight loss.
Implications and Recommendations
- Weight loss improves liver health, with a decline in ALT levels observed in those losing ≥5% of body weight.
- Proactive measures are needed to support weight management, including:
- Nutritional counseling and structured dietary plans.
- Emphasis on sustained lifestyle changes.
- Regular monitoring to prevent weight regain.
Recommendations for Patients:
- Set realistic goals: Aim for incremental weight loss milestones.
- Combine dietary interventions with moderate physical activity for better outcomes.
- Seek support from healthcare providers specializing in liver disease and obesity management.
Recommendations for Providers:
- Screen for NAFLD in obese patients and monitor weight trends over time.
- Incorporate behavioral counseling as part of routine care.
- Advocate for broader access to multidisciplinary weight management programs.
Future Directions
- Ongoing research aims to identify tailored dietary approaches for individuals with NAFLD, optimizing metabolic benefits while minimizing barriers to adherence.
- Advances in digital health tools, such as weight-tracking apps and virtual dietitian consultations, may enhance accessibility and engagement in weight loss programs.
- Exploration of pharmacological adjuncts to complement lifestyle interventions for NAFLD is underway, with early results showing promise.
Although weight loss is challenging for people with NAFLD/NASH, both intensive diet programs and real world approaches show promise. Tailored interventions that address individual barriers, coupled with ongoing support, can lead to improvements in liver health and well being. The path to weight management is complex, but with persistence and comprehensive care, substantial progress is surely possible.