1. Weight Loss via Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis
Gastroenterology 2015, /j.gastro
Eduardo Vilar-Gomez, Yadina Martinez-Perez, Luis Calzadilla-Bertot, Ana Torres-Gonzalez, Bienvenido Gra-Oramas, Licet Gonzalez-Fabian, Scott L. Friedman, Moises Diago, Manuel Romero-Gomez
Veronika Hechler, Bern

2. Background
Nonalcoholic fatty liver disease (NAFLD) has emerged as a leading cause of chronic liver disease worldwide
Associated with an increased risk of diabetes and ischemic heart disease
NAFLD encompasses a spectrum ranging from bland steatosis to steatohepatitis (NASH), the more aggressive form of NAFLD -> may progress to cirrhosis
Currently no approved therapies for NASH
Aim: changes in serological and histological features of NASH through weight loss by lifestyle modifications
Veronika Hechler, Bern

3. Methods
Prospective study of 293 patients with histologically proven NASH
Patients encouraged to adopt recommended lifestyle changes (hypocaloric diet combined with exercise) to reduce their weight
Duration: 52 weeks, from June 2009 through May 2013
Liver biopsies collected and analyzed histologically at the beginning of the study and at week 52
Veronika Hechler, Bern

4. In/exclusion criteria
Inclusion criteria:
Patients aged ≥ 18 years with histological diagnosis of definite NASH
Patients who accepted to participate in a lifestyle intervention program
Diabetic patients only if moderately well controlled (HbA1c<9) for ≥3 months
Eclusion criteria:
Histological diagnoses of borderline steatohepatitis or cirrhosis
alcohol consumption of > 20g/d for ♂ and > 10g/d for ♀during last 2 years
Other causes of liver disease (viral, autoimmune, drug-induced, Wilson, …)
Veronika Hechler, Bern

5. Results
25% of patients had resolution of steatohepatitis, 47% had reductions in NAS (NAFLD activity score), 19% had regression of fibrosis
Degree of weight loss associated with improvements in all NASH-related histological parameters (odds ratio, ; P<.01)
Patients with ≥5% weight loss had more NASH resolution and NAS ruduction than patients with <5% weight loss (P<.001)
No significant correlations between changes in physical activity score and weight loss percentage (r=0.07, P=0.45)
Veronika Hechler, Bern

6. Graphic presentation

7. Conclusions
a greater extent of weight loss, induced by lifestyle changes, is associated with level of improvement in histologic features of NASH
highest rates of NAS reduction, NASH resolution and fibrosis regression occurred in patients with weight losses of ≥10%
Veronika Hechler, Bern

8. Thank you for your attention!
Veronika Hechler, Bern