Is weight reduction an effective therapy for nonalcoholic fatty liver?: A systematic review

doi:10.1016/S0002-9343(03)00449-2

The American Journal of Medicine

Volume 115, Issue 7, November 2003, Pages 554-559

https://doi.org/10.1016/S0002-9343(03)00449-2 Get rights and content

Abstract

Purpose

To assess the evidence supporting the efficacy of weight reduction for patients with nonalcoholic fatty liver.

Methods

Potentially relevant studies were identified by a computerized search of databases and a manual search of abstracts from scientific meetings. Studies were included if they reported histology, serum aminotransferase levels, or radiological imaging of the liver in obese adult patients who had undergone weight reduction. Weight reduction regimens included diet, exercise, antiobesity medications, gastric bypass, gastroplasty, or any combination of these interventions. Studies involving jejunoileal or small bowel bypass surgery were excluded.

Results

We identified 517 potentially relevant studies, of which 15 met the inclusion criteria: one randomized controlled trial (in abstract form), two nonrandomized controlled trials, nine case series, one retrospective review, and two case reports. Three studies included more than 50 patients, whereas nine studies had 25 or fewer patients. Twelve studies used behavioral, dietary, or pharmacologic therapy for weight reduction, and three studies used surgical interventions. Although all 15 studies demonstrated overall improvement in the measurements of liver outcome after weight reduction, more than half did not report histologic results.

Conclusion

Despite general acceptance that weight reduction is an effective therapy for nonalcoholic fatty liver, this systematic review found little data to support or refute this recommendation.

Section snippets

Methods

Potentially relevant studies were identified by searching the Cochrane Hepato-Biliary Group Controlled Trials Register (February 2002), the Cochrane Controlled Trials Register on The Cochrane Library (Issue 1, 2002), MEDLINE (1965 to 2001), EMBASE (1985 to 2001), the Science Citation Index (1980 to 2001), Biological Abstracts (1980 to 2001), Current Contents (1980 to 2001), the Papers First database (1980 to 2001), and the Proceedings database (1980 to 2001). In addition, manual searches were

Results

The database search identified 500 citations and the manual search identified 17 studies. Communication with principal authors did not uncover any new studies. Of the 517 potentially relevant studies identified, only 15 met inclusion criteria (four abstracts, 11 published papers), which included one randomized and two nonrandomized controlled trials, and 12 case series, retrospective reviews, or case reports (Table 1). Three of the studies included more than 50 patients, of which only one has

Discussion

The goal of this paper was to evaluate the evidence supporting the recommendation of weight reduction in overweight patients with nonalcoholic fatty liver 1, 2, 11 by means of a meta-analysis. However, our systematic review of the existing data determined that the studies were inadequate to permit such a formal data combination. Indeed, the evidence supporting the recommendation was limited and sometimes of lower quality.

First, only 15 studies met the inclusion criteria, of which four were

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The important role of nutrition in the trajectory of chronic liver disease has long been recognized as exemplified by the fact that nutritional status was one of the variables of the original prognostic score introduced by Child and Turcotte. Yet, not all hepatologists consider nutrition issues relevant in the management of their patients. In this chapter, the scientific and evidence base for nutritional metabolic management in patients with liver disease is reviewed including appropriate recommendations.
European guideline on obesity care in patients with gastrointestinal and liver diseases – Joint ESPEN/UEG guideline
2022, Clinical Nutrition
Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence.
The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity.
The present guideline was developed according to the standard operating procedure for ESPEN guidelines, following the Scottish Intercollegiate Guidelines Network (SIGN) grading system (A, B, 0, and good practice point (GPP)). The procedure included an online voting (Delphi) and a final consensus conference.
In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity – including sarcopenic obesity – is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician.
The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
ESPEN practical guideline: Clinical nutrition in liver disease
2020, Clinical Nutrition
The Practical guideline is based on the current scientific ESPEN guideline on Clinical Nutrition in Liver Disease.
It has been shortened and transformed into flow charts for easier use in clinical practice. The guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with chronic liver disease.
A total of 103 statements and recommendations are presented with short commentaries for the nutritional and metabolic management of patients with (i) acute liver failure, (ii) alcoholic steatohepatitis, (iii) non-alcoholic fatty liver disease, (iv) liver cirrhosis, and (v) liver surgery/transplantation. The disease-related recommendations are preceded by general recommendations on the diagnostics of nutritional status in liver patients and on liver complications associated with medical nutrition.
This practical guideline gives guidance to health care providers involved in the management of liver disease to offer optimal nutritional care.
Biochemical changes associated with low and very low calorie diets on lipid metabolism, iron profile and kidney function in obese rats
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Obesity is the most prevalent nutritional disorder. Healthy diets helps people maintain and improve their general health. This study aimed to assessment of low and very low calorie diets through determination of its effect on lipid metabolism, iron profile and kidney function in obese male rats. To achieve our aim forty five male albino rats were used and divided into 4 groups: control group, obese group with 75 calories diet, obese group with 60 calories diet and obese group with 45 calories diet. Our result showed significant disturbance of lipid, iron and kidney profile on supplementation of 75 calories diet to obese group of male rats and significant improvement in lipid, iron and kidney profile on supplementation of 60 calories diet or 45 calories diet to obese group of male rats. The results confirmed that, high fat diet able to produce significant disturbance in lipid metabolism, iron profile and kidney function while low calorie diets able to improving the disturbance in such parameter.
An obese patient with acute cholecystitis, nonalcoholic steatohepatitis and cirrhosis: A case report
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Citation Excerpt :
A laparoscopic cholecystostomy is even less invasive. Several reports have shown that a low-carbohydrate diet is effective in obese patients [3–5], and weight loss by diet and exercise are both effective in patients with nonalcoholic steatohepatitis (NASH) [6–9]. We present an obese patient with acute cholecystitis and liver cirrhosis caused by NASH, who was successfully managed with laparoscopic cholecystostomy and low-carbohydrate diet with exercise, followed by open cholecystectomy.
Laparoscopic cholecystectomy for patients with acute cholecystitis and liver cirrhosis is associated with increased risk. We present an obese patient with acute cholecystitis and liver cirrhosis caused by nonalcoholic steatohepatitis (NASH), who was successfully managed with laparoscopic cholecystostomy and a low-carbohydrate diet with exercise.
A 61-year-old woman presented with right upper quadrant abdominal pain. Ultrasonography and computed tomography were consistent with acute cholecystitis with multiple stones and cirrhosis. The patient had no history of alcohol intake, and serologic tests were negative. The patient’s body mass index was 39 kg/m² (154 cm, 93 kg) and NASH was suspected. Percutaneous transhepatic drainage was impossible because of the anatomic position of the gallbladder. Emergency laparoscopic cholecystostomy was performed initially for drainage. A low-carbohydrate diet and exercise were started for weight loss and her weight reduced by 19 kg over three months. Open cholecystectomy was performed uneventfully, and liver biopsy suggested NASH.
Laparoscopic cholecystostomy is a reasonable temporary alternative to cholecystectomy in patients with acute cholecystitis and increased surgical risk. Weight loss with diet and exercise can be effective in patients with NASH. A low-carbohydrate diet is a reasonable treatment for NASH, because glucose is converted to triglycerides and stored as lipid in the liver.
Laparoscopic cholecystostomy was effective in this obese patient with acute cholecystitis and NASH cirrhosis. Using a low-carbohydrate diet with exercise, her weight decreased, and subsequent open cholecystectomy was uneventful.
ESPEN guideline on clinical nutrition in liver disease
2019, Clinical Nutrition
This update of evidence-based guidelines (GL) aims to translate current evidence and expert opinion into recommendations for multidisciplinary teams responsible for the optimal nutritional and metabolic management of adult patients with liver disease. The GL was commissioned and financially supported by ESPEN. Members of the guideline group were selected by ESPEN.
We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method.
A total of 85 recommendations were made for the nutritional and metabolic management of patients with acute liver failure, severe alcoholic steatohepatitis, non-alcoholic fatty liver disease, liver cirrhosis, liver surgery and transplantation as well as nutrition associated liver injury distinct from fatty liver disease. The recommendations are preceded by statements covering current knowledge of the underlying pathophysiology and pathobiochemistry as well as pertinent methods for the assessment of nutritional status and body composition.

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^☆: This work was supported in part by grants from the National Institutes of Health (R01 DK61532, K08 DK02450, U01 DK61738), Bethesda, Maryland, and the American College of Gastroenterology, Alexandria, Virginia.

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ReviewIs weight reduction an effective therapy for nonalcoholic fatty liver?: A systematic review☆

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Gastroenterology

Hum Pathol

Gastroenterology

Hepatology

J Hepatol

J Hepatol

Gastroenterology

Gastroenterology

Reviewnon-alcoholic steatohepatitis

J Gastroenterol Hepatol

Non-alcoholic steatohepatitis

Ann Intern Med

The natural history of non-alcoholic steatohepatitisa follow up study of forty-two patients for up to 21 years

Hepatology

Cryptogenic cirrhosisclinical characterization and risk factors for underlying disease

Hepatology

Non-alcoholic steatohepatitisMayo Clinic experiences with a hitherto unnamed disease

Mayo Clin Proc

Fatty liver hepatitis (steatohepatitis) and obesityan autopsy study with analysis of risk factors

Hepatology

Review
Is weight reduction an effective therapy for nonalcoholic fatty liver?: A systematic review☆