Metabolic fitness programs viable therapeutic option for fatty liver disease
WASHINGTON — Patients with fatty liver disease reduced their BMI and alanine aminotransferase levels following a regimented health education, nutrition and exercise program, according to study results presented at Emerging Trends in Non-Alcoholic Fatty Liver Disease.
“Highly structured lifestyle programs with regimented diet and exercise components often have the highest efficacy for weight loss,” Monica Konerman, MD, MSc, of the department of gastroenterology and hepatology at the University of Michigan, said during her presentation. “The reason that’s important is ... that approximately a 10% reduction in body weight is usually required to see histologic improvement. Many of the existing regimented lifestyle programs are targeting towards patients with either cardiac or endocrine disease, but these types of programs likely represent potential therapeutic options for patients with NAFLD.”
Konerman presented results of a study that analyzed the outcomes of patients enrolled in the University of Michigan Metabolic Fitness Program, originally designed for patients with cardiovascular diseases.
The 12-week program consisted of 45 minutes each day of an educational lecture on nutrition, exercise and how components such as stress and behavior feed into metabolic syndrome. This was followed by 45 minutes of a moderate intensity aerobic and resistance based exercise session supervised by exercise physiologists to provide safety, education and individualized feedback.
The study comprised 495 patients, 236 of whom had evidence of underlying NAFLD. The mean age of the NAFLD cohort was 51.8 years (range, 45-59 years), 61.8% were men, 88.9% were white, average BMI was 38.5 (range, 34.4-42.6), average ALT was 40 (range, 25-56) and 123 had abnormal ALT of greater than 35 IU/L (P < .001). The mean age of the cohort of patients without NAFLD was 55 years (range, 47-62 years), 64.8% were men, 84.8% were white, average BMI was 36.2 (range, 31.9-42), average ALT was 25.5 (range, 20-34) and 49 had abnormal ALT (P < .001).
Overall, 22.5% of the enrolled patients achieved a 5% reduction of baseline weight, 5% achieved a 10% or greater reduction of baseline weight, 23.7% achieved resolution of impaired fasting glucose, 69% achieved resolution of hypertriglyceridemia and 36.2% normalized their ALT. Specifically, 27.3% of the NAFLD cohort and 17.6% of the patients without NAFLD achieved a 5% reduction of BMI. Researchers observed that the change in ALT was –5 in the NAFLD cohort vs. –2 in the patients without NAFLD. At the end of the program, 30 patients in the NAFLD cohort and 21 of the patients without NAFLD had an abnormal ALT.
“This program overall was efficacious for achieving weight loss ... however, only 5% [of overall patients] achieved a goal of 10% weight loss,” Konerman concluded. “This again reinforces the need for ongoing investigation into other methods to optimize lifestyle interventions for these patients; also, we need to take a look at long-term outcomes after completion of these types of programs.” – by Talitha Bennett
Konerman MA. Impact of a structured exercise, nutrition and patient education program on short term outcomes in patients with non-alcoholic fatty liver disease. Presented at: Emerging Trends in Non-Alcoholic Fatty Liver Disease; March 18-19, 2017; Washington.
Disclosure: Konerman reports no relevant financial disclosures.
Editor's note: This has been updated with clarifications from the presenter.