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Total Body Weight Loss of ≥10 % Is Associated with Improved Hepatic Fibrosis in Patients with Nonalcoholic Steatohepatitis

Abstract

Background

Given the rising epidemics of obesity and metabolic syndrome, nonalcoholic steatohepatitis (NASH) is now the most common cause of liver disease in the developed world. Effective treatment for NASH, either to reverse or prevent the progression of hepatic fibrosis, is currently lacking.

Aim

To define the predictors associated with improved hepatic fibrosis in NASH patients undergoing serial liver biopsies at prolonged biopsy interval.

Methods

This is a cohort study of 45 NASH patients undergoing serial liver biopsies for clinical monitoring in a tertiary care setting. Biopsies were scored using the NASH Clinical Research Network guidelines. Fibrosis regression was defined as improvement in fibrosis score ≥1 stage. Univariate analysis utilized Fisher’s exact or Student’s t test. Multivariate regression models determined independent predictors for regression of fibrosis.

Results

Forty-five NASH patients with biopsies collected at a mean interval of 4.6 years (±1.4) were included. The mean initial fibrosis stage was 1.96, two patients had cirrhosis and 12 patients (26.7 %) underwent bariatric surgery. There was a significantly higher rate of fibrosis regression among patients who lost ≥10 % total body weight (TBW) (63.2 vs. 9.1 %; p = 0.001) and who underwent bariatric surgery (47.4 vs. 4.5 %; p = 0.003). Factors such as age, gender, glucose intolerance, elevated ferritin, and A1AT heterozygosity did not influence fibrosis regression. On multivariate analysis, only weight loss of ≥10 % TBW predicted fibrosis regression [OR 8.14 (CI 1.08–61.17)].

Conclusion

Results indicate that regression of fibrosis in NASH is possible, even in advanced stages. Weight loss of ≥10 % TBW predicts fibrosis regression.

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Fig. 1

Abbreviations

ALT:

Alanine aminotransferase

AASLD:

American Association for the Study of Liver Diseases

AST:

Aspartate aminotransferase

BMI:

Body mass index

DHMC:

Dartmouth–Hitchcock Medical Center

IRB:

Institutional Review Board

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

NAS:

NAFLD activity score

SPSS 19:

Statistical Package for the Social Sciences

TBW:

Total body weight

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Acknowledgments

The authors would like to thank Dr. Stephen Caldwell for his thoughtful review and input on the manuscript.

Conflict of interest

Dickson, disclosures for Gilead, BMS.

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Authors

Corresponding author

Correspondence to Rolland C. Dickson.

Appendix

Appendix

See Table 4.

Table 4 Fibrosis staging according to the NASH Clinical Research Network

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Glass, L.M., Dickson, R.C., Anderson, J.C. et al. Total Body Weight Loss of ≥10 % Is Associated with Improved Hepatic Fibrosis in Patients with Nonalcoholic Steatohepatitis. Dig Dis Sci 60, 1024–1030 (2015). https://doi.org/10.1007/s10620-014-3380-3

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  • DOI: https://doi.org/10.1007/s10620-014-3380-3

Keywords

  • Nonalcoholic fatty liver disease
  • Nonalcoholic steatohepatitis
  • Fibrosis