Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life

Background and aim: Obesity is a risk factor for progression of fibrosis in chronic liver diseases such as non-alcoholic fatty liver disease and hepatitis C. 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.

Patients: Thirty one patients completed a 15 month diet and exercise intervention.

Results: On completion of the intervention, 21 patients (68%) had achieved and maintained weight loss with a mean reduction of 9.4 (4.0)% body weight. Improvements in serum alanine aminotransferase (ALT) levels were correlated with the amount of weight loss (r = 0.35, p = 0.04).

In patients who maintained weight loss, mean ALT levels at 15 months remained significantly lower than values at enrolment (p = 0.004), while in regainers (n = 10), mean ALT levels at 15 months were no different to values at enrolment (p = 0.79). Improvements in fasting serum insulin levels were also correlated with weight loss (r = 0.46, p = 0.04), and subsequent weight maintenance sustained this improvement.

Quality of life was significantly improved after weight loss. Weight maintainers sustained recommended levels of physical activity and had higher fasting insulin levels (p = 0.03) at enrolment than weight regainers.

Conclusion: In summary, 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. Treatment of overweight patients should form an important component of the management of those with chronic liver disease.

Keywords: hepatitis C; obesity; insulin resistance; non-alcoholic fatty liver disease; quality of life

Abbreviations: HCV, hepatitis C virus; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; BMI, body mass index; HOMA, homeostasis model of assessment; ALT, alanine aminotransferase; HRQL, health related quality of life; SF36, short form 36; PCS, physical component score; MCS, mental component score

I J Hickman1, J R Jonsson2, J B Prins3, S Ash4, D M Purdie5, A D Clouston2 and E E Powell6

1 School of Medicine, University of Queensland, and Department of Nutrition and Dietetic Services, Princess Alexandra Hospital, Brisbane, Australia
2 School of Medicine, University of Queensland, Brisbane, Australia
3 Department of Endocrinology and Diabetes, Princess Alexandra Hospital, Brisbane, Australia
4 Nutrition and Dietetic Services, Princess Alexandra Hospital, Brisbane, Australia
5 Population and Clinical Sciences Division, Queensland Institute of Medical Research, Brisbane, Australia
6 School of Medicine, University of Queensland, and Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia

Correspondence to:
Dr E Powell
Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Qld, 4102, Australia;
Elizabeth_Powellhealth.qld.au

Source: GUT (Journal)
gut.bmjjournals/cgi/content/abstract/53/3/413?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=weight+loss&searchid=1076848208801_356&stored_search=&FIRSTINDEX=0&volume=53&issue=3&journalcode=gutjnl