Dose-response Relationship Between Weight Loss and Improvements in NAFLD

Takeaway

• This meta-analysis suggests a dose-response relationship between weight loss and improvements in biomarkers of liver disease in people with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH).
• Clinically significant improvements in liver disease are achieved even with modest weight loss, but greater weight loss is associated with greater improvements.

Why this matters

• Findings suggest that embedding support for weight loss as part of the clinical care pathway for the treatment of NAFLD could reduce the burden of disease.

Study design

• 43 studies including 2809 participants met eligibility criteria after a search across MEDLINE, Embase, and other electronic databases.
• Funding: National Institute for Health Research Oxford Biomedical Research Centre.

Key results

• Every 1 kg of weight loss was associated with a:
  • 0.83-unit (95% CI, 0.53-1.14; I², 92%; P<.0001) reduction in alanine aminotransferase (U/L);
  • 0.56-unit (95% CI, 0.32-0.79; I², 68%; P<.0001) reduction in aspartate transaminase (U/L); and
  • 0.77 percentage point (95% CI, 0.51-1.03; I², 72%; P<.0001) reduction in steatosis assessed by histology or radiology.
• Weight loss correlated with other radiological or histological markers, including liver inflammation (β=0.02; 95% CI, 0.01-0.04; P=.0005), ballooning (β=0.03; 95% CI, 0.02-0.03; P<.0001); and resolution of NAFLD or NASH (OR, 1.23; 95% CI, 1.03-1.47; I², 93%; P=.022).
• The evidence on improvements in histological liver fibrosis was inconsistent and imprecise (β=0.02; 95% CI, 0.00-0.04; P=.037).
• No evidence was found that weight loss was associated with histological reduction in the NAFLD activity score (β=0.11; 95% CI, −0.01 to 0.22; I², 89%; P=.077).

Limitations

• Heterogeneity among included studies.

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.