COMMENTARY

Seeking Less-Invasive Care in Obesity-Related Liver Disease

Digestive Disease Week (DDW) 2017

William F. Balistreri, MD

Disclosures

July 28, 2017

Texting for Better Outcomes

In the absence of effective, pharmacological approaches approved by the US Food and Drug Administration, the only management strategy for patients with obesity/NAFLD is weight reduction via lifestyle changes. Achievement of the recommended 7% to 10% loss of baseline body weight typically requires an intensive, closely monitored program.

Axley and coworkers[3] tested the hypothesis that a text messaging approach to remind and reiterate recommendations provided during a clinic visit would result in better compliance and greater success in achieving this goal.

Well-characterized patients with NAFLD were randomly assigned to receive either standard of care with instructions offered in the clinic (healthy diet and daily exercise for weight loss) or additional text messages on their cell phone (3 messages every week related to nutrition, exercise, and stress management). The baseline characteristics of the two study groups were not significantly different, except for the higher proportion of females in the text message group (88% vs 46%; P < .001). At the end of 6 months, the text message group lost an average of 11 lb pounds (approximately 5% of their baseline body weight), with a decrease in ALT level (mean, 20 IU/L). In comparison, the control group had no significant change in weight (1.6lb) or ALT level (−7.8 IU/L).

All participants who received text messages responded to a survey at the end of the study, confirming their satisfaction with the program and recommending it to their friends and relatives.

Larger studies of a longer duration and follow-up using this approach are needed to assess the effect on liver histology and surrogate markers of survival in patients with NAFLD.

Bariatric Surgery Risks

Several studies have documented the beneficial effects of various bariatric surgical procedures, including a durable weight loss and reversal of comorbidities. With the large number of patients who have undergone these procedures, there are now sufficient long-term data to assess the incidence of unintended consequences and serious adverse events.

Questioning specifically whether bariatric procedures increase the risk for acute liver failure, Wander and colleagues[4] retrospectively analyzed discharge data on patients who developed acute liver injury, using the Nationwide Inpatient Sample database (2010-2013). They compared patients with a history of bariatric surgery with all other patients with an inpatient diagnosis of acute liver injury. They reviewed the records of 437,390 patients diagnosed with acute liver injury, of whom 3799 had previously undergone bariatric surgery.

The prevalence of acute liver injury was higher in patients who had a history of bariatric surgery (0.85%) than in those who did not (0.72%). Post-bariatric-surgery patients admitted for acute liver injury were more likely to be younger (25-49 years of age), female, Caucasian, and residing in more affluent areas; they also had higher rates of malnutrition, anemia, and alcoholism.

The investigators concluded that bariatric surgery increases the risk for subsequent acute liver injury. They hypothesized that baseline nutritional status may predispose to drug-induced acute liver injury, and therefore, that addressing these potentially modifiable risk factors may decrease the significant morbidity and mortality of acute liver injury.

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