Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Abstract

Summary Background Lifestyle interventions are first‐line therapy for non‐alcoholic fatty liver disease (NAFLD). Aims To examine the prevalence of NAFLD among participants of the University of Michigan Metabolic Fitness (MetFit) Programme and to assess the impact of this programme on weight, metabolic and liver‐related parameters among patients with and without NAFLD. Methods Adults who completed the programme between 2008 and 2016 were included. Clinical and laboratory data were collected at enrolment, and at 12 and 24 weeks. NAFLD was defined based on liver biopsy, imaging or clinical diagnosis. Results The cohort (N = 403; 253 12‐week, 150 24‐week) consisted primarily of middle‐aged (median 54 years) white (88%) men (63%) with severe obesity (median BMI 37.4). 47.6% met criteria for NAFLD. At baseline, NAFLD patients were younger (52 vs 55 years), had higher weights and more metabolic derangements (higher fasting insulin and triglyceride, lower high‐density lipoprotein‐cholesterol). At programme completion, 30% achieved weight reduction ≥5%, 62% resolution of hypertriglyceridaemia, 33% resolution of low HDL, 27% resolution of impaired fasting glucose and 43% normalisation of alanine aminotransferase. Endpoints were unaffected by NAFLD. Longer programme duration (OR 6.7, 95% CI 3.6‐12.3) and white race (OR 3.83, 95% CI 1.04‐1.76) were independent predictors of ≥5% weight loss. Conclusions Nearly half of the patients referred to a structured lifestyle programme for metabolic syndrome had NAFLD. Although baseline metabolic derangements were more pronounced among NAFLD patients, the programme was equally efficacious in achieving weight loss and resolving metabolic syndrome components. Programme duration was the most important predictor of response.

Prevalence and staging of non-alcoholic fatty liver disease among patients with heart failure with preserved ejection fraction

“…Caloric restriction and aerobic exercise training additively improve exercise capacity in HFpEF, representing two of the only evidence-based therapies for the condition 29 . Similarly, structured nutrition and exercise interventions in NAFLD patients have successfully achieved weight loss is associated with improvements in degree of hepatic steatosis, inflammation and fibrosis 30 . Therefore, metabolic fitness programs could be designed to target both HFpEF and NAFLD concurrently 31 .…”

“…This high disease prevalence is clinically significant as patients with NAFLD have been shown to have increased mortality compared to matched controls without NAFLD, and given that the presence of NAFLD is associated with a 26% higher health care cost 20,21 . NAFLD patients have also been shown to have more severe metabolic derangements compared to individuals with obesity without NAFLD, making their clinical management more challenging 22 .…”

Managing NAFLD in Type 2 Diabetes: The Effect of Lifestyle Interventions, a Narrative Review

“…It is unclear whether patients with both NAFLD and T2D respond differently to an intervention compared to those with NAFLD or T2D in isolation. Konerman et al [61] investigated the effects of a multidisciplinary lifestyle intervention in patients with the metabolic syndrome who were grouped on the basis of the presence or absence of NAFLD (diagnosed by either imaging or liver biopsy). The intervention involved one session a week for 12 or 24 weeks (participants were given the option as to which program to undertake).…”

Результаты Обсервационного Перекрестного Исследования PRELID 2 (2015–2016). Часть 2. Факторы Риска Неалкогольной Жировой Болезни Печени И Методы Лечения Болезни У пациентов, Обращающихся К Терапевтам И Гастроэнтерологам В Украине

“…До них належать такі фактори ризику, як ожиріння, діабет, гіпертонія та дисліпідемія [2]. Крім того, патогенез НАЖХП також включає генетичні, демографічні, клінічні й екологічні фактори [3,4]. Стать і вік є важливими в розвитку НАЖХП, поширеність якої, як правило, вище в чоловіків [5][6][7].…”