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Hohenester S, Christiansen S, Nagel J, Wimmer R, Artmann R, Denk G, Bischoff M, Bischoff G, Rust C. Lifestyle intervention for morbid obesity: effects on liver steatosis, inflammation, and fibrosis. Am J Physiol Gastrointest Liver Physiol 2018; 315:G329-G338. [PMID: 29878845 DOI: 10.1152/ajpgi.00044.2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The prevalence of obesity-related nonalcoholic fatty liver disease (NAFLD) is rising. NAFLD may result in nonalcoholic steatohepatitis (NASH), progressing to liver cirrhosis. Weight loss is recommended to treat obesity-related NASH. Lifestyle intervention may improve NASH; however, pertinent trials have so far focused on overweight patients, whereas patients with obesity are at highest risk of developing NAFLD. Furthermore, reports of effects on liver fibrosis are scarce. We evaluated the effect of lifestyle intervention on NAFLD in a real-life cohort of morbidly obese patients. In our observational study, 152 patients underwent lifestyle intervention, with a follow-up of 52 weeks. Noninvasive measures of obesity, metabolic syndrome, liver steatosis, liver damage, and liver fibrosis were analyzed. Treatment response in terms of weight loss was achieved in 85.1% of patients. Dysglycemia and dyslipidemia improved. The proportion of patients with fatty liver dropped from 98.1 to 54.3% ( P < 0.001). Weight loss >10% was associated with better treatment response ( P = 0.0009). Prevalence of abnormal serum transaminases fell from 81.0 to 50.5% ( P < 0.001). The proportion fibrotic patients, as determined by the NAFLD fibrosis score, dropped from 11.8 to 0% ( P < 0.05). Low serum levels of adiponectin correlated with degree of liver damage, i.e., serum liver transaminases ( r = -0,32, P < 0.05). Serum levels of adiponectin improved with intervention. In conclusion, lifestyle intervention effectively targeted obesity and the metabolic syndrome. Liver steatosis, damage and fibrosis were ameliorated in this real-life cohort of morbidly obese patients, mediated in part by changes in the adipokine profile. Patients with weight loss of >10% seemed to benefit most. NEW & NOTEWORTHY We demonstrate new evidence that lifestyle intervention is effective in treating NAFLD in the important group of patients with (morbid) obesity. Although current guidelines on the therapy of NASH recommend weight loss of 5-7%, weight reduction >10% may be favorable in morbid obesity. Serum levels of adipokines correlate with liver damage, which is indicative of their pathogenetic importance in human NASH. Our study adds to the limited body of evidence that NAFLD-associated liver fibrosis may resolve with lifestyle intervention.
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Affiliation(s)
- Simon Hohenester
- Department of Medicine II, University Hospital, LMU Munich, Munich , Germany
| | - Simon Christiansen
- Center for Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder , Munich , Germany
| | - Jutta Nagel
- Department of Medicine II, University Hospital, LMU Munich, Munich , Germany
| | - Ralf Wimmer
- Department of Medicine II, University Hospital, LMU Munich, Munich , Germany
| | - Renate Artmann
- Department of Medicine II, University Hospital, LMU Munich, Munich , Germany
| | - Gerald Denk
- Department of Medicine II, University Hospital, LMU Munich, Munich , Germany
| | - Monika Bischoff
- Center for Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder , Munich , Germany
| | - Gert Bischoff
- Center for Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder , Munich , Germany.,Department of Medicine I, Hospital Barmherzige Brüder , Munich , Germany
| | - Christian Rust
- Center for Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder , Munich , Germany.,Department of Medicine I, Hospital Barmherzige Brüder , Munich , Germany
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