Department of Medicine II, University Hospital, LMU Munich.
Center for clinical nutrition and preventive medicine, Hospital Barmherzige Brüder.
Department of Medicine, University Hospital, LMU Munich.
Department of Medicine I, Hospital Barmherzige Brüder.
Department of Medicine I, Hospital Barmherzige Brüder, Germany.
Background The prevalence of obesity-related non-alcoholic fatty liver disease (NAFLD) is rising. NAFLD may result in non-alcoholic steatohepatitis (NASH), progressing to liver cirrhosis. Weight loss is recommended to treat obesity-related NASH. Lifestyle intervention may improve NASH. However, pertinent trials have so far focused on overweight patients, while patients with obesity are at highest risk of developing NAFLD. Furthermore, reports of effects on liver fibrosis are scarce. We evaluated the effect of lifestyle intervention on NAFLD in a real-life cohort of morbidly obese patients. Methods In our observational study 152 patients underwent lifestyle intervention with follow-up of 52 weeks. Non-invasive measures of obesity, metabolic syndrome, and liver steatosis, liver damage, and liver fibrosis were analyzed. Results Treatment response in terms of weight loss was achieved in 85.1%. Dysglycemia and dyslipidemia improved. The proportion of patients with fatty liver dropped from 98.1% to 54.3% (p<0.001). Weight loss >10% was associated with better treatment response (p=0.0009). Prevalence of abnormal serum transaminases fell from 81.0% to 50.5% (p<0.001). The proportion fibrotic patients, as determined by the NAFLDfibrosis score, dropped from 11.8% to 0% (p<0.05). Low serum levels of adiponectin correlated with degree of liver damage, i.e. serum liver transaminases (г=-0,32, p<0.05). Serum levels of adiponectin improved with intervention. Conclusion Lifestyle intervention effectively targeted obesity and the metabolic syndrome. Liver steatosis, damage and fibrosis were ameliorated in this real-life cohort of morbidly obese patients - mediated, in part, by changes in the adipokine profile. Patients with weight loss of >10% seemed to benefit most.