Intensive weight-loss does not improve outcomes in obese NAFLD patients

An intensive weight-loss intervention has failed to substantially improve the treatment outcomes among obese patients with nonalcoholic fatty liver disease (NAFLD), reports a recent study.

A group of researchers randomly assigned 140 patients aged 18‒69 years with obesity and NAFLD into an intervention (n=70) or a control (n=70) group at a tertiary-care hospital.

They measured the weight, anthropometric parameters, Controlled Attenuation Parameter (CAP), Liver Stiffness Measurement (LSM), liver enzymes, grade of fatty liver, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) at baseline and at 6 months.

A high dropout rate was observed, which was further exacerbated by the COVID-19 pandemic. Only 59 participants completed the study, 30 in the intervention group and 29 controls. The researchers implemented an intention-to-treat analysis.

Significantly more participants in the intervention arm had normalized alanine transaminase (ALT) than those in the control arm at 6 months (66.7 percent vs 18.2 percent). No marked improvements were noted in other metabolic, ultrasound, or anthropometric outcomes.

Significant improvements were also seen in weight (p<0.001), aspartate transaminase (p=0.01), ALT (p=0.02), body fat% (p<0.001), waist circumference (p<0.001), and CAP (p<0.001) within the intervention arm, along with a trend in improvement in steatosis and HOMA-IR.

On the other hand, participants in the control arm had a marked reduction in weight (p<0.001), waist circumference (p<0.001), and CAP (p=0.02).

Nearly twice the number of participants in the intervention arm lost at least 5-percent weight relative to those in the control arm (46.7 percent vs 24.1 percent; p=0.07).

“However, given the potential of our intervention, we recommend larger trials with more intensive weight-loss interventions,” the researchers said.