Impact of a Structured Lifestyle Programme on Patients With Metabolic Syndrome Complicated by Non-alcoholic Fatty Liver Disease

Monica A. Konerman; Patrick Walden; Megan Joseph; Elizabeth A. Jackson; Anna S. Lok; Melvyn Rubenfire


Aliment Pharmacol Ther. 2019;49(3):296-307. 

In This Article

Abstract and Introduction


Background: Lifestyle interventions are first-line therapy for non-alcoholic fatty liver disease (NAFLD).

Aims: To examine the prevalence of NAFLD among participants of the University of Michigan Metabolic Fitness (MetFit) Programme and to assess the impact of this programme on weight, metabolic and liver-related parameters among patients with and without NAFLD.

Methods: Adults who completed the programme between 2008 and 2016 were included. Clinical and laboratory data were collected at enrolment, and at 12 and 24 weeks. NAFLD was defined based on liver biopsy, imaging or clinical diagnosis.

Results: The cohort (N = 403; 253 12-week, 150 24-week) consisted primarily of middle-aged (median 54 years) white (88%) men (63%) with severe obesity (median BMI 37.4). 47.6% met criteria for NAFLD. At baseline, NAFLD patients were younger (52 vs 55 years), had higher weights and more metabolic derangements (higher fasting insulin and triglyceride, lower high-density lipoprotein-cholesterol). At programme completion, 30% achieved weight reduction ≥5%, 62% resolution of hypertriglyceridaemia, 33% resolution of low HDL, 27% resolution of impaired fasting glucose and 43% normalisation of alanine aminotransferase. Endpoints were unaffected by NAFLD. Longer programme duration (OR 6.7, 95% CI 3.6–12.3) and white race (OR 3.83, 95% CI 1.04–1.76) were independent predictors of ≥5% weight loss.

Conclusions: Nearly half of the patients referred to a structured lifestyle programme for metabolic syndrome had NAFLD. Although baseline metabolic derangements were more pronounced among NAFLD patients, the programme was equally efficacious in achieving weight loss and resolving metabolic syndrome components. Programme duration was the most important predictor of response.


Obesity has become a worldwide public health crisis given its prevalence and multiple associated complications including non-alcoholic fatty liver disease (NAFLD). Metabolic syndrome (MetSyn) is highly correlated with prevalent and incident NAFLD. Approximately 46% of patients with NAFLD have concomitant MetSyn, and odds of developing NAFLD are significantly higher among patients with baseline MetSyn (odds ratios [OR] 4 for men and 11.2 for women).[1,2] The presence of MetSyn has been identified as a predictor for underlying non-alcoholic steatohepatitis (NASH) among patients with NAFLD, and the total number of metabolic risk factors in an individual NAFLD patient is correlated with risk of liver disease progression.[3,4] First-line treatment for metabolic disease associated with obesity including NAFLD is lifestyle interventions. From a liver perspective, multiple studies have demonstrated improvement in hepatic steatosis and histologic components of NASH among patients who are able to achieve weight loss.[5,6] While 10% reduction in body weight is generally required to resolve steatosis, inflammation and fibrosis, a more modest reduction (3%-5%) has been shown to decrease steatosis.

In clinical practice, it can be challenging for patients to implement lifestyle changes. Highly structured lifestyle programmes often have the highest efficacy for weight loss. One such programme is the University of Michigan Metabolic Fitness (MetFit) Programme. Although many regimented lifestyle programmes were initially targeted for patients with MetSyn with cardiology and endocrinology referral bases, these types of programmes represent potential therapeutic options for patients with NAFLD. The aims of this study were (a) to evaluate the prevalence of NAFLD among participants enrolled in the MetFit Program and to characterise their patterns of clinical care and (b) to assess the impact of the MetFit Program among participants with and without NAFLD and to identify predictors of achieving significant weight loss at programme completion.