Changes in body weight are associated with changes in biochemical and histological features of nonalcoholic steatohepatitis (NASH). Guidelines for NASH treatment should therefore include advice on avoiding weight gain and supporting weight loss.
This is what researchers from the United Kingdom write in their article that recently appeared in Clinical Gastroenterology and Hepatology. They conducted this study because NASH patients are often advised to lose weight, but what effect losing weight really has on disease activity is still unclear. The researchers analyzed data from 2 trials (PIVENS and FLINT) on 421 adult NASH patients for whom liver biopsies were available at baseline and at 1.5 or 2 years. The body mass index of these patients was on average 34.3 kg/m2 (SD: 6.5) and the mean change in body weight was +0.5 kg (SD: 6.5).
Multivariate regression models analyzed how change in body weight was associated with change in (a) blood liver values, (b) reduction in NASH without exacerbation of fibrosis, (c) improvement in fibrosis without exacerbation of NASH and (d) individual histological features.
Change in body weight was found to be associated with changes in liver enzymes and the Fibrosis-4 score (all p < 0.001). The probability of achieving a reduction in NASH (without exacerbation of fibrosis) increased by 7% (95% CI: 3-10%; p < 0.001) for each kilogram of weight loss and by 5% (95% CI: 1 -8%; p = 0.01) per kilo for amelioration of fibrosis without worsening NASH.
In addition, for every kilogram of weight lost, the chance of improving fibrosis increased by 5% (95% CI: 2-8%; p = 0.001). Weight gain was actually associated with worsening disease activity.
Bron:
Koutoukidis DA, Susan A. Jebb SA, Tomlinson JW, et al. Association of Weight Changes With Changes in Histological Features and Blood Markers in Nonalcoholic Steatohepatitis. Clinical Gastroenterology and Hepatology. 2022;20:e538-e547.