Luo Ling, Shao Congxiang, Dong Zhi, Zhuo Shuyu, Feng Shiting, Wang Wei, Ye Junzhao, Zhong Bihui
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510080, China.
Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510080, China.
Biomedicines. 2025 Sep 4;13(9):2161. doi: 10.3390/biomedicines13092161.
Weight loss is the primary therapy for metabolic dysfunction-associated steatotic liver disease (MASLD). However, the proportion and factors influencing therapeutic changes in the liver condition contrary to weight loss remain unclear. : This observational cohort study spanned between January 2015 and January 2024, with a 48-week lifestyle modification until January 2025. The liver fat content (LFC) determined using MRI-PDFF and liver stiffness measurement (LSM) via 2D-SWE were assessed at baseline and 48 weeks. The weight loss target (WLT) was determined as a reduction of ≥3% in body weight for lean/normal-weight patients and ≥5% for patients who were overweight/obese. : Overall, 397 patients with MASLD (30.5% achieving WLT) were included. For participants with WLT, 24.8% presented MRI-PDFF non-response, which was associated with moderate-vigorous physical activity (MVPA) ≥ 150 min/week, indicating a lower likelihood of non-response. Alanine aminotransferase (ALT) non-response occurred in 29.6% of patients and was linked to changes in LFC (ΔLFC, calculated as the baseline minus week 48). LSM non-response was observed in 48.2%, with high free fatty acid (FFA) levels identified as a risk factor. Among individuals without WLT, 29.0% demonstrated an MRI-PDFF response that correlated with greater reductions in low-density lipoprotein cholesterol; 39.4% exhibited an ALT response, which was associated with more significant reductions in LFC. The LSM response was 37.8%, also correlating with a reduction in LFC. : Our results identified that MVPA, baseline steatosis degree, FFA, and their responses served as significant markers for treatment response contrary to weight loss in MASLD.
减肥是代谢功能障碍相关脂肪性肝病（MASLD）的主要治疗方法。然而，与体重减轻相反，影响肝脏状况治疗变化的比例和因素仍不清楚。 ：这项观察性队列研究跨越2015年1月至2024年1月，进行为期48周的生活方式调整，直至2025年1月。在基线和48周时，通过MRI-PDFF测定肝脏脂肪含量（LFC），并通过二维剪切波弹性成像（2D-SWE）测量肝脏硬度（LSM）。体重减轻目标（WLT）确定为：瘦/正常体重患者体重减轻≥3%，超重/肥胖患者体重减轻≥5%。 ：总体而言，纳入了397例MASLD患者（30.5%达到WLT）。对于达到WLT的参与者，24.8%表现为MRI-PDFF无反应，这与每周中等至剧烈身体活动（MVPA）≥150分钟有关，表明无反应的可能性较低。29.6%的患者出现丙氨酸氨基转移酶（ALT）无反应，这与LFC变化（ΔLFC，计算为基线减去第48周）有关。48.2%观察到LSM无反应，高游离脂肪酸（FFA）水平被确定为一个危险因素。在未达到WLT的个体中，29.0%表现出与低密度脂蛋白胆固醇更大幅度降低相关的MRI-PDFF反应；39.4%表现出ALT反应，这与LFC更显著降低有关。LSM反应为37.8%，也与LFC降低相关。 ：我们的结果表明，MVPA、基线脂肪变性程度、FFA及其反应是MASLD中与体重减轻相反的治疗反应的重要标志物。
