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 Most people have a little bit of fat in their liver, but fatty liver
disease can be diagnosed when more than 5% of the liver is made up
of fat. If the condition isn't linked to liver damage from heavy
drinking, it's known as non-alcoholic fatty liver disease (NAFLD)
and is most often associated with obesity and certain eating habits.
For the current analysis, researchers examined data on 2,588
patients who were participating in 22 clinical trials of various
interventions to help them lose weight. Fifteen studies tested
behavioral weight loss programs; six tested medications; one tested
weight loss surgery.
The trials also looked at whether those interventions would improve
biomarkers for NAFLD that can help predict the likelihood of serious
complications.
Compared with little or no weight loss support, the interventions
that offered the most support were associated with greater weight
loss and bigger reductions in biomarkers for NAFLD like elevated
liver enzymes in the blood, elevated blood sugar, and reduced
sensitivity to the hormone insulin, or insulin resistance.
"It shows clearly that weight loss improves the health of the
liver," said Dimitrios Koutoukidis, a researcher at the University
of Oxford in the U.K. and lead author of the study.
"We found some evidence that weight loss improved NAFLD through
improvements in the control of blood glucose levels and reductions
in insulin resistance, but we need more research to understand the
exact mechanisms," Koutoukidis said by email.
Different approaches to weight loss didn't appear to impact whether
fibrosis, or scarring, in the liver got better or worse.
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Worldwide, about one in four adults have NAFLD, as do at least half
of people with obesity, researchers note in JAMA Internal Medicine.
There's no drug treatment for NAFLD. Doctors typically advise
patients to lose weight by cutting calories and getting more
exercise, or sometimes by taking weight-loss medications or
considering weight-loss surgery. The new findings, according to the
researchers, "appear to support the need to change the clinical
guidelines and to recommend formal weight loss programs for people
with NAFLD."
One limitation of the analysis is that the smaller studies tested a
wide range of weight-loss interventions over varying lengths of time
and used different tests to assess patients' liver disease.
Still, weight loss through a combination of dietary improvements and
increased exercise can improve fatty liver, said Dr. Danielle
Brandman, director of the Fatty Liver Clinic at the University of
California San Francisco and coauthor of an editorial accompanying
the study.
Ideally, patients should try to lose 7% of their weight and maintain
this weight loss in order to have long-term improvements in NAFLD,
Brandman said by email.
"Patients have the potential to improve or cure their disease,"
Brandman said.
"However, they should know that this is an ultra-marathon rather
than a sprint," Brandman added. "Weight loss - and the behavior
change needed to achieve it - can be really difficult for many
patients for a variety of reasons."
SOURCE: http://bit.ly/2ZZq9Cs JAMA Internal Medicine, online July 1,
2019.
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