Department of Medicine II, University Hospital, LMU Munich, Munich , Germany.
Center for Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder , Munich , Germany.
Am J Physiol Gastrointest Liver Physiol. 2018 Sep 1;315(3):G329-G338. doi: 10.1152/ajpgi.00044.2018. Epub 2018 Jun 7.
The prevalence of obesity-related nonalcoholic fatty liver disease (NAFLD) is rising. NAFLD may result in nonalcoholic steatohepatitis (NASH), progressing to liver cirrhosis. Weight loss is recommended to treat obesity-related NASH. Lifestyle intervention may improve NASH; however, pertinent trials have so far focused on overweight patients, whereas patients with obesity are at highest risk of developing NAFLD. Furthermore, reports of effects on liver fibrosis are scarce. We evaluated the effect of lifestyle intervention on NAFLD in a real-life cohort of morbidly obese patients. In our observational study, 152 patients underwent lifestyle intervention, with a follow-up of 52 weeks. Noninvasive measures of obesity, metabolic syndrome, liver steatosis, liver damage, and liver fibrosis were analyzed. Treatment response in terms of weight loss was achieved in 85.1% of patients. Dysglycemia and dyslipidemia improved. The proportion of patients with fatty liver dropped from 98.1 to 54.3% ( P < 0.001). Weight loss >10% was associated with better treatment response ( P = 0.0009). Prevalence of abnormal serum transaminases fell from 81.0 to 50.5% ( P < 0.001). The proportion fibrotic patients, as determined by the NAFLD fibrosis score, dropped from 11.8 to 0% ( P < 0.05). Low serum levels of adiponectin correlated with degree of liver damage, i.e., serum liver transaminases ( r = -0,32, P < 0.05). Serum levels of adiponectin improved with intervention. In conclusion, lifestyle intervention effectively targeted obesity and the metabolic syndrome. Liver steatosis, damage and fibrosis were ameliorated in this real-life cohort of morbidly obese patients, mediated in part by changes in the adipokine profile. Patients with weight loss of >10% seemed to benefit most. NEW & NOTEWORTHY We demonstrate new evidence that lifestyle intervention is effective in treating NAFLD in the important group of patients with (morbid) obesity. Although current guidelines on the therapy of NASH recommend weight loss of 5-7%, weight reduction >10% may be favorable in morbid obesity. Serum levels of adipokines correlate with liver damage, which is indicative of their pathogenetic importance in human NASH. Our study adds to the limited body of evidence that NAFLD-associated liver fibrosis may resolve with lifestyle intervention.
非酒精性脂肪性肝病（NAFLD）与肥胖相关，其患病率正在上升。NAFLD 可能导致非酒精性脂肪性肝炎（NASH），进而发展为肝硬化。建议通过减轻体重来治疗肥胖相关的 NASH。生活方式干预可能改善 NASH；然而，迄今为止，相关试验主要集中在超重患者，而肥胖患者患 NAFLD 的风险最高。此外，关于对肝纤维化影响的报告很少。我们评估了生活方式干预对病态肥胖患者中 NAFLD 的影响。在我们的观察性研究中，152 名患者接受了生活方式干预，随访 52 周。分析了肥胖、代谢综合征、肝脂肪变性、肝损伤和肝纤维化的非侵入性指标。85.1%的患者达到了减重治疗反应。血糖和血脂紊乱得到改善。脂肪肝患者的比例从 98.1%降至 54.3%（P < 0.001）。体重减轻>10%与更好的治疗反应相关（P = 0.0009）。异常血清转氨酶的患病率从 81.0%降至 50.5%（P < 0.001）。通过 NAFLD 纤维化评分确定的纤维化患者比例从 11.8%降至 0%（P < 0.05）。脂联素血清水平与肝损伤程度相关，即血清肝转氨酶（r = -0.32，P < 0.05）。脂联素血清水平随着干预而改善。总之，生活方式干预有效地针对肥胖和代谢综合征。在这一病态肥胖患者的真实队列中，肝脂肪变性、损伤和纤维化得到改善，部分原因是脂联素谱的变化。体重减轻>10%的患者似乎获益最大。新的和值得注意的是，我们提供了新的证据，证明生活方式干预在肥胖患者（病态肥胖）的 NAFLD 治疗中是有效的。尽管目前关于 NASH 治疗的指南建议减轻体重 5-7%，但在病态肥胖中，减轻体重>10%可能是有利的。脂联素血清水平与肝损伤相关，这表明其在人类 NASH 中的发病机制中具有重要意义。我们的研究增加了有限的证据，表明 NAFLD 相关的肝纤维化可能通过生活方式干预而缓解。
