Long‐term prognosis of nonalcoholic fatty liver disease: Is pharmacological therapy actually necessary?

Çınar, Kubilay; İdilman, Ramazan; Tüzün, Ali; Sarioglu, Mustafa; Bektaş, Mehmet; Erden, Esra; Bozkaya, Hakan; Ozden, Ali

doi:10.1111/j.1440-1746.2005.04221.x

Cited by 11 publications

(14 citation statements)

References 22 publications

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“…In study other are in disagreement with my study (28,30,32,33). Kate hallsworth et al had only drug intervention (vitamin E) but Kittichachi and Shah had life style intervention and D + E same as our study.…”

Section: Discussioncontrasting

confidence: 55%

How Does Addition of Regular Aerobic Exercises, Influence the Efficacy of Calorie-Restricted Diet in Patients with Non-Alcoholic Steatohepatatis (NASH)?

et al. 2017

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Background: Nonalcoholic fatty liver (NAFLD) is a worldwide, leading cause of chronic liver disease, not yet approved medical treatment standards. The aim is to assess the effects of aerobic exercise sand calorie-restricted (CR) diet on many clinical and laboratory findings in patients with Nonalcoholic Steatohepatatis (NASH). Methods: In Randomized controlled trial study, in Mashhad, between February 2010 -August 2011, Twenty-five patients with NASH, in ranging ages of 18 -55, were randomly selected to be divided in to two groups, who received CR-diet and aerobic exercise (n = 12) and CR-diet alone (n = 13). We measured Anthropometric indices, cardio-respiratory fitness, and biochemical profiles in three steps, in baseline, and after 8 -12 weeks of intervention. We measured hepatic steatosis and patient's quality of life by ultra-sonography and short form (questionnaire) 36 in three steps. Data was then analyzed by paired and independent samples T Test. Results: We observed a significant improvement in BP, FBS, TG, HOMA-IR, ultra-sonography grading of steatosis and quality of life, only in patients who received aerobic exercises. (P value 0.021, 0.005, 0.006, 0.042, 0.010 and 0.012). Waist circumference, waist-toheight ratio, serum ALT and peak oxygen consumption improved in both groups; however, improvement was significantly, higher in patients who received aerobic exercises (P value 0.027, 0.011, 0.020 and 0.020). Body weight, BMI, body fat percentage and AST improved in both groups but they were not significantly different. No significant changes noted in total cholesterol, LDL and HDL in groups. Conclusions: Add of aerobic exercises to CR diets can, not only enhance the therapeutic effects of calorie-restricted diet, but also bring more benefits in patients with NASH.

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Section: Discussioncontrasting

confidence: 55%

How Does Addition of Regular Aerobic Exercises, Influence the Efficacy of Calorie-Restricted Diet in Patients with Non-Alcoholic Steatohepatatis (NASH)?

et al. 2017

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“…It does not appear that weight loss is essential to create improvement in liver histology as other researchers have formerly reported [Cinar et al 2006;Zelber-Sagi et al 2007;Promrat et al 2009;Vilar et al 2009]. The majority of our study population did not experience significant weight loss and several study participants actually gained weight with improvement in liver histology.…”

Section: Discussionmentioning

confidence: 48%

“…Treatments including drug therapy, bariatric surgery, and lifestyle modification, have all demonstrated weight loss success. Research has shown that rapid weight loss from bariatric surgery may damage the liver and medication may not provide any substantial benefit that cannot be achieved with lifestyle modification alone [Harrison and Day, 2007;Huang et al 2005;Cinar et al 2006]. Prospective studies evaluating changes in liver histology following successful weight loss through lifestyle modification, in addition to the most beneficial type of lifestyle modification to improve liver histology in NAFLD/NASH, are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies investigating low-fat and lowcarbohydrate diets for NAFLD have reported conflicting results. Disparity also exists in defining the macronutrient distribution appropriate for a low-fat or low-carbohydrate diet in this population [Youssefand McCullough, 2002;Cinar et al 2006;Solga et al 2004;Schwarz et al 2003;Sato et al 2007;Westerbacka et al 2005;Kechagias et al 2008;Tendler et al 2007]. Refined carbohydrates and saturated fat may have a greater potential to increase liver lipid content as these dietary components are known to increase hepatic production of cholesterol and triglycerides [Fletcher et al 2005].…”

Section: Introductionmentioning

confidence: 99%

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Prospective histopathologic evaluation of lifestyle modification in nonalcoholic fatty liver disease: a randomized trial

Eckard¹,

Cole²,

Lockwood

et al. 2013

Therap Adv Gastroenterol

132

134

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Background and aims: Nonalcoholic fatty liver disease (NAFLD) is now recognized as part of the metabolic syndrome, and is specifically related to obesity and insulin resistance. Lifestyle modification is advocated for the treatment of NAFLD, but few studies have evaluated its impact on liver histology. The purpose of this study was to investigate which, if any, specific diet and exercise recommendations are associated with histopathologic changes. Methods: A total of 56 participants were randomly assigned to 1 of 4 lifestyle modification subgroups for 6 months: standard care, low-fat diet and moderate exercise, moderate-fat/lowprocessed-carbohydrate diet and moderate exercise, or moderate exercise only. All subjects had biopsy-proven NAFLD, to include nonalcoholic steatohepatitis (NASH), and received a repeat 6-month biopsy to detect histopathologic changes. Other measures included blood assay of liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase), fasting glucose, serum insulin, lipid panel, body weight, dietary intake, fat mass, and fitness level. Results: Among the 41 participants who completed the study (88% with NASH), a significant change was found in pre-to post-NAFLD activity score in the group as a whole (p < 0.001) with no difference detected between subgroups (p = 0.31). Our results confirm that lifestyle modification is effective in improving NAFLD and NASH. Conclusions: Regardless of intervention group, lifestyle modification improved liver histology, as verified by repeat biopsy, after a 6-month intervention. This study reinforces the importance of lifestyle modification as the primary treatment strategy for patients with NAFLD.

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“…A number of studies suggest that NAFLD improves after weight loss. Improvements in liver biochemistry and ultrasonographic appearances have been found with modest weight reduction, but few studies have evaluated the effects of weight reduction on hepatic histology 45,54,55 …”

Section: Lifestyle Modificationmentioning

confidence: 99%

How should we manage patients with non‐alcoholic fatty liver disease in 2007?

Chan

Silva

Leung

et al. 2007

J of Gastro and Hepatol

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Evidence-based management guidelines for non-alcoholic fatty liver disease (NAFLD) are lacking in the Asia-Pacific region or elsewhere. This review reports the results of a systematic literature search and expert opinions. TheAsia-Pacific Working Party on NAFLD (APWP-NAFLD) has generated practical recommendations on management of NAFLD in this region. NAFLD should be suspected when there are metabolic risk factors and/or characteristic changes on hepatic ultrasonography. Diagnosis by ultrasonography, assessment of liver function and complications, exclusion of other liver diseases and screening for metabolic syndrome comprise initial assessment. Liver biopsy should be considered when there is diagnostic uncertainty, for patients at risk of advanced fibrosis, for those enrolled in clinical trials and at laparoscopy for another purpose. Lifestyle measures such as dietary restrictions and increased physical activity (aerobic exercise) should be encouraged, although the best management strategy to achieve this has yet to be defined. Complications of metabolic syndrome should be screened for regularly. Use of statins to treat hypercholesterolemia is safe and recommended; frequent alanine aminotransferase (ALT) monitoring is not required. Obese patients who do not respond to lifestyle measures should be referred to centers specializing in obesity management; consideration should be given to bariatric surgery or gastric ballooning. The role of pharmacotherapy remains investigational and is not recommended for routine clinical practice. Non-alcoholic fatty liver disease should be recognized as part of the metabolic syndrome and managed in a multidisciplinary approach that addresses liver disease in the context of risk factors for diabetes and premature cardiovascular disease. Lifestyle changes are the first line and mainstay of management.

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Long‐term prognosis of nonalcoholic fatty liver disease: Is pharmacological therapy actually necessary?

Cited by 11 publications

References 22 publications

How Does Addition of Regular Aerobic Exercises, Influence the Efficacy of Calorie-Restricted Diet in Patients with Non-Alcoholic Steatohepatatis (NASH)?

How Does Addition of Regular Aerobic Exercises, Influence the Efficacy of Calorie-Restricted Diet in Patients with Non-Alcoholic Steatohepatatis (NASH)?

Prospective histopathologic evaluation of lifestyle modification in nonalcoholic fatty liver disease: a randomized trial

How should we manage patients with non‐alcoholic fatty liver disease in 2007?

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