Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; Centre for Nutritional Studies, The Chinese University of Hong Kong, Hong Kong.
J Hepatol. 2018 Dec;69(6):1349-1356. doi: 10.1016/j.jhep.2018.08.011. Epub 2018 Aug 22.
BACKGROUND & AIMS: Around 10-20% of patients with non-alcoholic fatty liver disease (NAFLD) are non-obese. The benefit of weight reduction in such patients is unclear. We aim to study the efficacy of lifestyle intervention in non-obese patients with NAFLD and to identify factors that predict treatment response.
A total of 154 community NAFLD patients were randomised to a 12-month lifestyle intervention programme involving regular exercise, or to standard care. The primary outcome was remission of NAFLD at Month 12 by proton-magnetic resonance spectroscopy. After the programme, the patients were prospectively followed until Year 6. The Asian body mass index (BMI) cut-off of 25 kg/m was used to define non-obese NAFLD.
Patients were assigned to the intervention (n = 77) and control (n = 77) groups (39 and 38 in each group had baseline BMI <25 and ≥25 kg/m, respectively). More patients in the intervention group achieved the primary outcome than the control group regardless of baseline BMI (non-obese: 67% vs. 18%, p <0.001; obese: 61% vs. 21%, p <0.001). Lifestyle intervention, lower baseline intrahepatic triglyceride, and reduction in body weight and waist circumference were independent factors associated with remission of NAFLD in non-obese patients. Half of non-obese patients achieved remission of NAFLD with 3-5% weight reduction; the same could only be achieved in obese patients with 7-10% weight reduction. By Year 6, non-obese patients in the intervention group remained more likely to maintain weight reduction and alanine aminotransferase normalisation than the control group.
Lifestyle intervention is effective in treating NAFLD in both non-obese and obese patients. Weight reduction predicts remission of NAFLD in non-obese patients, but a modest weight reduction may be sufficient in this population.
Some patients with non-alcoholic fatty liver disease (NAFLD) are non-obese. The optimal management of such patients is unclear. In this long-term follow-up study of a clinical trial, we show that remission of NAFLD can be achieved in 67% of non-obese patients after lifestyle intervention. The majority of patients can achieve NAFLD remission with modest weight loss of 3-10%. Non-obese patients are also more likely than obese patients to maintain weight reduction and normal liver enzymes in the long run.
约 10-20%的非酒精性脂肪性肝病（NAFLD）患者非肥胖。此类患者减轻体重的益处尚不清楚。我们旨在研究生活方式干预对非肥胖 NAFLD 患者的疗效，并确定预测治疗反应的因素。
共有 154 例社区 NAFLD 患者被随机分配至为期 12 个月的生活方式干预方案（包括定期运动）或标准护理。主要结局是通过质子磁共振波谱在第 12 个月时 NAFLD 缓解。方案结束后，前瞻性随访患者直至第 6 年。采用亚洲体重指数（BMI）截断值 25kg/m2 定义非肥胖性 NAFLD。
患者被分配至干预组（n=77）和对照组（n=77）（基线 BMI<25kg/m2 的患者分别有 39 例和 38 例，≥25kg/m2 的患者分别有 38 例和 39 例）。与对照组相比，干预组更多患者达到主要结局，且与基线 BMI 无关（非肥胖组：67%比 18%，p<0.001；肥胖组：61%比 21%，p<0.001）。生活方式干预、较低的基线肝内甘油三酯以及体重和腰围的减轻是与非肥胖患者 NAFLD 缓解相关的独立因素。一半的非肥胖患者通过减轻 3-5%体重即可缓解 NAFLD；而肥胖患者则需要减轻 7-10%体重才能达到同样效果。随访至第 6 年时，与对照组相比，干预组的非肥胖患者更有可能保持体重减轻和丙氨酸氨基转移酶正常化。
生活方式干预对非肥胖和肥胖的 NAFLD 患者均有效。体重减轻可预测非肥胖患者的 NAFLD 缓解，但在该人群中适度减轻体重可能就足够了。
非肥胖性非酒精性脂肪性肝病（NAFLD）患者的最佳治疗方法尚不清楚。在这项临床试验的长期随访研究中，我们发现生活方式干预可使 67%的非肥胖患者的 NAFLD 得到缓解。大多数患者通过减轻 3-10%的体重即可实现 NAFLD 缓解。从长远来看，非肥胖患者比肥胖患者更有可能保持体重减轻和肝脏酶正常化。
