Changes in alanine aminotransferase in adults with severe and complicated obesity during a milk-based meal replacement programme

Abstract

Introduction Excess adiposity is associated with fat accumulation within the liver, and non-alcoholic steatohepatitis (NASH) is highly prevalent in bariatric patients. Elevated alanine aminotransferase (ALT) is associated with prevalent NASH. We sought to determine the influence of a milk-based meal replacement weight-loss programme on ALT levels in adults with severe and complicated obesity. Methods We conducted a retrospective cohort study of patients who completed a 24-week meal replacement programme, comprised of a weight loss phase followed by weight stabilisation and maintenance phases, each 8 weeks long. ALT was quantified using an enzymatic assay with spectrophotometric detection. We examined changes over time in ALT using the non-parametric Wilcoxon singed-rank test and the Friedman test. Results Of 105 patients, 56 were female, mean age was 51.2 ± 11.2 (range 18.0–71.6) years. There was an unanticipated but transient increase in ALT from 28.0 [20.0, 40.5] iu/L at baseline to 40.0 [26.0, 55.0] iu/L after 2 weeks (p < 0.0005), followed by a gradual reduction to 21.0 [17.0, 28.3] iu/L by 24 weeks (p < 0.0005). The overall reductions in ALT were more pronounced in patients who had elevated levels at baseline. Body weight decreased from 144.2 ± 28.0 kg at baseline to 121.6 ± 25.4 kg at 24 weeks (p < 0.0005) and body mass index (BMI) decreased from 50.7 ± 8.1 kg m−2 at baseline to 43.0 ± 7.6 kg m−2 by 24 weeks (p < 0.0005). Conclusion In adults with severe and complicated obesity undergoing a milk-based meal replacement programme, there was an initial unanticipated rise in ALT in the first 2 weeks, followed by a gradual overall reduction by 24 weeks. These findings suggest that rapid weight loss secondary to significant caloric restriction might induce a transient deterioration in hepatic steatosis prior to an ultimate overall improvement.

Results from three phase 1 trials of NNC9204-1177, a glucagon/GLP-1 receptor co-agonist: Effects on weight loss and safety in adults with overweight or obesity

“…In addition, increased levels of liver enzymes (AST and ALT) were noted; however, there were no concerning cases in specific participants and no clear evidence of hepatocellular injury. There is evidence to suggest that some liver enzymes may transiently increase during a diet-induced weight loss with the effect considered due to a transient deterioration in hepatic steatosis prior to improvement, and therefore a benign effect [ 48 , 49 ]. In contrast, however, a previous phase 2 trial with semaglutide in participants with obesity showed decreases in liver enzymes (ALT) and hsCRP [ 50 ]; indeed, GLP-1 RAs such as liraglutide and semaglutide are known to reduce inflammation as measured by hsCRP [ 51 ].…”

A comprehensive review of meal replacement from dining table to sickbed: beyond biomedical potentials

“…In a retrospective cohort study of 105 patients of serious and intricate obesity with NASH, milk-based MR unexpectedly increased ALT within the first 2 weeks. However, it finally led to an overall reduction after 24 weeks besides weight loss [41] .…”

Efektivitas Susu Tinggi Protein dalam Menurunkan Berat Badan dan Pencegahan Obesitas: Scoping Review

“…Penelitian lainnya yang dilakukan Abdalgwad dkk. didapatkan perubahan berat badan pada populasi obesitas berat disertai dengan fluktuasi kadar ALT (11). Abdalgwad dkk.…”

“…Abdalgwad dkk. menjelaskan bahwa kenaikan ALT hingga minggu keempat intervensi disebabkan oleh peningkatan asam lemak tidak teresterifikasi yang mengaktivasi ALT untuk memproduksi asam lemak sebagai kompensasi atas penurunan asupan kalori yang didapatkan oleh tubuh, sehingga berat badan dapat menurun akibat proses tersebut (11). Sedangkan pada minggu keempat hingga seterusnya terdapat penurunan kadar ALT dikarenakan asupan kalori dan berat badan telah stabil (12).…”