Updated : Nov 08, 2019 in Research Articles

NAFLD Patients Less Likely to Lose Weight, Need More Effective Weight Loss Strategies

BOSTON – Data from a new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – found that obese individuals with nonalcoholic fatty liver disease (NAFLD) were less likely to achieve a medically recommended five percent loss of body weight at three months on a very-low-calorie diet compared to obese counterparts without NAFLD. The study’s authors, based in Melbourne, Australia, concluded that more research is needed into weight homeostasis in people with NAFLD to help them optimize weight loss strategies and improve their health.

For people with NAFLD, weight loss is the only recommended treatment. Loss of five percent or more of body weight has been shown to improve the amount of fat found in the liver. Unfortunately, weight loss in real-world settings is difficult for patients to achieve. This led the researchers to investigate whether weight loss strategies widely used for obese patients could be adapted for patients with NAFLD and incorporated into their management strategies.

“Globally, obesity and NAFLD are an increasing cause of significant morbidity and mortality, with few effective weight loss strategies available. As our understanding of the physiology of obesity and weight homeostasis evolves, so too does our approach to the management of weight loss,” says Ann Farrell, MBBS, a gastroenterology fellow at St. Vincent’s Hospital in Melbourne and the study’s lead author. “The medical management of obesity is centered around use of the very-low-calorie diet to produce significant loss of weight. However, there is some evidence to suggest that patients with type-2 diabetes mellitus lose less weight on these programs than those without diabetes. As NAFLD is associated with insulin resistance, we attempted to review whether there was any difference in the weight loss outcomes achieved by NAFLD patients at our obesity management clinic.”

Patients included in the study began an 800-calorie diet to achieve weight loss. The study defined NAFLD as a fatty liver index (FLI) of greater than 60, and the primary outcome was at least five percent loss of body weight after three months of attending the clinic. The study followed 410 patients who attended a special weight management clinic at St. Vincent’s Hospital in Melbourne between July 2015 and February 2019. Thirty-three percent of the patients were male, and their median age was 46. The researchers were able to calculate FLI for 213 individuals, and 113 or 53 percent met the criteria for an NAFLD diagnosis. Those with NAFLD were 42 percent male with a median age of 48, and they had a higher average fasting blood glucose and alamine transaminase (ALT) level than other participants. They were also less likely to have a childhood history of obesity than those without NAFLD. Baseline FibroScan® results were available for 63 patients with an FLI, and an NAFLD diagnosis was associated with patients who had a significantly higher median liver stiffness measurement.

The study’s results showed that only 48 percent of patients with NAFLD managed to achieve their target weight loss of at least five percent compared to 66.1 percent of patients without NAFLD. Individual components of the FLI, including an individual’s BMI, waist circumference, and gamma glutamyltransferase (GGT) and triglyceride levels had no significant effect on the probability of patients achieving their target weight loss alone. 

“We found that a smaller proportion of patients with NAFLD were able to achieve the target five percent loss of total body weight at three months compared to those with a non-diagnostic fatty liver index,” explains Dr. Farrell of the findings. “In our further analysis, this difference was no longer evident when the cohort was followed to six months. This suggests that while obese patients with NAFLD can still achieve significant weight loss on a very-low-calorie diet, they may be slower to reach this point. Further studies are required to confirm if there are any significant differences in the rate of weight loss in patients with NAFLD. Overall, the weight loss achieved through this outpatient-based diet program was significant. This is a strategy that should be considered in the management of obese patients with NAFLD moving forward.”

Editor’s Note: This study is ongoing, and updated results will be presented at The Liver Meeting®.

Dr. Farrell will present the study entitled “ADAPTING MEDICAL WEIGHT LOSS STRATEGIES TO NAFLD: IS IT EFFECTIVE?” on Sunday, Nov. 10 at 10:30 AM in the Auditorium of the Hynes Convention Center. The corresponding abstract (number 0065) can be found in the journal, HEPATOLOGY.

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Abstract 0065: ADAPTING MEDICAL WEIGHT LOSS STRATEGIES TO NAFLD – IS IT EFFECTIVE?

Authors: Dr. Ann Farrell1,2, Hayden Green2, Dr. James Williams1 and Dr. Marno C Ryan1,2, (1)Gastroenterology, St Vincent’s Hospital Melbourne, Victoria, Australia, (2)University of Melbourne

Abstract Text

Background:

In Nonalcoholic Fatty Liver Disease (NAFLD), loss of weight is the only recommended treatment, with a loss of >5% of body weight shown to improve steatosis. Unfortunately weight loss in a real world setting is difficult to achieve, and there is interest in adapting the weight loss strategies used in obesity, to the management of NAFLD. Medical weight loss services are increasingly using Very Low Energy Diets (VLED), which induce ketosis to suppress appetite while also achieving significant loss of weight. The success of these diets in obese individuals with NAFLD is unclear. We aim to review weight loss outcomes in obese individuals with NAFLD undergoing a VLED in an outpatient weight management clinic.

Methods:

This represents a retrospective cohort analysis of obese individuals attending the specialist weight management clinic at St Vincent’s Hospital Melbourne, Australia. All patients are commenced on an 800 calorie VLED to achieve loss of weight. NAFLD was defined as a Fatty Liver Index (FLI) of > 60, and the primary outcome was at least 5% loss of baseline body weight after 3 months of attending the clinic.

Results:

410 patients (33% male, mean age 46 ± 12yrs) attended the clinic between July 2015 and February 2019. FLI was able to be calculated for 213 individuals, and 113 (53%) met criteria for a diagnosis of NAFLD. Those with NAFLD (mean age of 48 ± 11yrs, 42% male), had a higher mean fasting blood glucose (7.3 ± 3.4mmol/L vs 6.3 ± 2.5mmol/L; p=0.04) and ALT (38.7 ± 27.1U/L vs 31.2

± 23.2U/L; p=0.03); and were less likely to have a childhood history of obesity (OR 0.37, 95%CI 0.19-0.73, p=0.004) than those without NAFLD. Baseline Fibroscan results were available in 63 patients with a FLI, and the diagnosis of NAFLD was associated with a significantly higher median Liver Stiffness Measurement (10.4kpa IQR 7.3-21.2, n=32 vs 7.3kpa IQR 5.3-10, n=31; p=0.002). Only 48% of patients with NAFLD managed to achieve the target weight loss of at least 5%, compared to 66.1% in those without NAFLD (c2(1), n= 126) = 4.02, p = 0.045). On multivariate analysis, the individual components of the FLI (BMI, waist circumference, GGT and triglycerides) had no significant effect on the probability of achieving the target weight loss alone.

Conclusion:

Obese individuals with NAFLD were less likely to achieve 5% loss of body weight at 3 months on a VLED compared to their obese counterparts without NAFLD. Further research into weight homeostasis in individuals with NAFLD is required, in order to optimize weight loss strategies.

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