Department of Endocrinology, Changi General Hospital, Singapore.
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
Liver Int. 2019 May;39(5):941-949. doi: 10.1111/liv.14065. Epub 2019 Feb 24.
BACKGROUND & AIMS: We compared the effects of weight loss induced with the glucagon-like peptide-1 agonist liraglutide, with that of lifestyle modification, followed by weight maintenance after discontinuing intervention, in obese adults with non-alcoholic fatty liver disease (NAFLD).
Thirty obese (mean age 40.7 ± 9.1 years, BMI 33.2 ± 3.6 kg/m , 90% male) adults with NAFLD defined as liver fat fraction (LFF) > 5% on magnetic resonance imaging without other causes of hepatic steatosis were randomized to a supervised programme of energy restriction plus moderate-intensity exercise to induce ≥ 5% weight loss (DE group, n = 15), or liraglutide 3 mg daily (LI group, n = 15) for 26 weeks, followed by 26 weeks with only advice to prevent weight regain.
Diet and exercise and LI groups had significant (P < 0.01) and similar reductions in weight (-3.5 ± 3.3 vs -3.0 ± 2.2 kg), LFF (-8.1 ± 13.2 vs -7.0 ± 7.1%), serum alanine aminotransferase (-39 ± 35 vs -26 ± 33 U/L) and caspase-cleaved cytokeratin-18 (cCK-18) (-206 ± 252 vs -130 ± 158 U/L) at 26 weeks. At 52 weeks, the LI group significantly (P < 0.05) regained weight (1.8 ± 2.1 kg), LFF (4.0 ± 5.3%) and cCK-18 (72 ± 126 U/L), whereas these were unchanged in the DE group.
Liraglutide was effective for decreasing weight, hepatic steatosis and hepatocellular apoptosis in obese adults with NAFLD, but benefits were not sustained after discontinuation, in contrast with lifestyle modification. Continuing the exercise learned in the structured programme contributed to the maintenance of liver fat reduction.
我们比较了胰高血糖素样肽-1 激动剂利拉鲁肽诱导的体重减轻，与生活方式改变后停止干预的体重维持，对非酒精性脂肪性肝病（NAFLD）肥胖成年人的影响。
30 名肥胖（平均年龄 40.7±9.1 岁，BMI 33.2±3.6kg/m ，90%男性）的成年人患有 NAFLD，定义为磁共振成像上的肝脂肪分数（LFF）>5%，没有其他肝脂肪变性的原因。他们被随机分为两组：接受能量限制和中等强度运动的监督方案，以诱导体重减轻≥5%（DE 组，n=15）；或每天接受利拉鲁肽 3mg（LI 组，n=15）治疗 26 周，然后仅接受预防体重反弹的建议 26 周。
饮食和运动组和 LI 组体重显著（P<0.01）且相似（分别为-3.5±3.3kg 和-3.0±2.2kg）、LFF（分别为-8.1±13.2%和-7.0±7.1%）、血清丙氨酸氨基转移酶（分别为-39±35 和-26±33U/L）和半胱氨酸蛋白酶切割细胞角蛋白 18（cCK-18）（分别为-206±252 和-130±158U/L）在 26 周时下降。在 52 周时，LI 组体重（1.8±2.1kg）、LFF（4.0±5.3%）和 cCK-18（72±126U/L）显著（P<0.05）增加，而 DE 组无变化。
利拉鲁肽可有效降低肥胖 NAFLD 成年人的体重、肝脂肪变性和肝细胞凋亡，但停药后益处不能持续，与生活方式改变不同。继续进行结构化方案中学习到的运动有助于维持肝脏脂肪减少。
