Weight Loss Helpful in Chronic Liver Disease

Laurie Barclay, MD

February 19, 2004

Feb. 20, 2004 -- Weight loss followed by maintenance for 15 months significantly improved liver tests, insulin levels, and quality of life for those with chronic liver disease, according to the results of an intervention trial published in the March issue of Gut.

"Obesity is a risk factor for progression of fibrosis in chronic liver diseases such as non-alcoholic fatty liver disease and hepatitis C," write I. J. Hickman, from the University of Queensland in Brisbane, Australia, and colleagues. "The aim of this study was to investigate the longer term effect of weight loss on liver biochemistry, serum insulin levels, and quality of life in overweight patients with liver disease and the effect of subsequent weight maintenance or regain."

To accomplish the goal of weight loss for three months followed by 12 months of weight maintenance, 31 overweight patients with fatty liver were seen by a dietician every week during the first three months and monthly thereafter, and they completed 2.5 hours of aerobic exercise every week for the entire study period. Before enrolling in the study, only 10 patients took part in regular exercise. After completion of the 15-month diet and exercise intervention, 21 (68%) of the 31 patients had achieved and maintained weight loss, with a mean reduction of 9.4 ± 4.0% body weight.

Reductions in serum alanine aminotransferase (ALT) levels were directly related to the amount of weight loss (r = .35; P = .04). Patients who maintained weight loss had lower mean ALT levels at 15 months than at baseline ( P = .004). However, the 10 patients who regained weight had no difference in mean ALT levels at 15 months compared with those at enrollment ( P = .79).

Weight loss also was associated with improvements in quality of life and in fasting serum insulin levels (r = .46; P = .04), and subsequent weight maintenance sustained improvements in insulin levels. Compared with patients who regained weight, those who maintained weight loss sustained recommended levels of physical activity and had higher fasting insulin levels ( P = .03) at enrollment.

Liver biopsies from 14 patients at the sixth through the ninth month of the study showed marked reduction in fatty infiltration.

"These findings demonstrate that maintenance of weight loss and exercise in overweight patients with liver disease results in a sustained improvement in liver enzymes, serum insulin levels, and quality of life," the authors write. "Treatment of overweight patients should form an important component of the management of those with chronic liver disease."

Study limitations include inability to test the relative contribution of dietary changes, weight loss, or increased physical activity to the improvement in liver enzymes and insulin levels.

However, the authors note that "one of the most important factors associated with successful weight maintenance was the continuation of appropriate levels of physical activity in the long term.... Our data further support the important role of exercise in the successful maintenance of weight loss in patients with chronic liver disease."

The National Health and Medical Research Council of Australia, the Gastroenterology Society of Australia Foundation, Pharmacia and Upjohn Research Fellowship (JJ), and the Princess Alexandra Hospital Research and Development Foundation helped fund this study and its investigators.

Gut. 2004;53:413-419

Reviewed by Gary D. Vogin, MD



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