The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients

Abstract

Background and aims: Weight loss through lifestyle modifications remains the mainstay for NAFLD treatment; however, implementing effective lifestyle interventions in clinical practice has been challenging due to time and cost constraints. Having a comprehensive approach to weight loss in patients with NAFLD that can be scaled and provided at low cost is a key unmet need. The objective of this study is to assess the effects of a mobile weight management program on weight loss and liver health biomarkers in adults with obesity and NAFLD. Method: Adults with obesity (BMI 30 to 49.9 kg/m 2 inclusive) and evidence of NAFLD based on Fibroscan CAP ≥274 dB/m were included. Patients were given access to the Noom Weight program for 16 weeks (midpoint) and then were followed for an additional 8 weeks (week 24 or end point). Measurements completed at baseline, midpoint, and end point included: weight/BMI, Fibroscan, routine labs (Complete Metabolic Panel and CBC), and the exploratory biomarker cytokeratin 18 fragment (CK18f). All tests of significance were performed at alpha = 0.05, two sided. Results: 40 subjects were enrolled and 82.5% (33/40) completed the study. The mean age was 55.9 years (range 29-79) with a mean BMI of 38 kg/m2 (30.5-49.8) and a mean baseline CAP score of 331.9 db/m 2 (276-396) and a mean LSM of 7.54 kPa (4.9-13.3). The average change in body weight from baseline was a 4.0% reduction and 32.4% (11/34) achieved total body weight reduction by 5% or more. There was a significant reduction in the CAP score by end point of 21.35 dB/ m (p = 0.024). The ALT decreased by 10 U/L or more in 27.3% (9/33). There was moderate correlation between BMI decrease and reduction in the CAP score (R = 0.533). There was no change in the LSM at the end point, and 62% (21) of subjects achieved >5% drop in CK18f. The change in CK18f correlated weakly (R = 0.215) with BMI drop but more strongly with Fibroscan CAP score (R = 0.468) and LSM (R = 0.764). Conclusion: The Noom Weight program had beneficial effects in patients with obesity and NAFLD, including significant reduction in the CAP score and one third of patients achieving 5% or more reduction in their weight. Steatosis of the liver was affected by weight loss as a result of engagement with the Noom Weight program. Fibrosis was not significantly affected by the Noom Weight program in the timeframe of the study. Fibrosis may require a longer timeframe for changes to be measured. FRI-526 The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients Background and aims: Non-alcoholic fatty liver disease (NAFLD) has become the most frequent cause of chronic liver disease. The leading cause of NAFLD has been defined as a behavioural phenotype comprising low physical activity and an obesogenic diet. The primary therapeutic advice is lifestyle changes leading to weight loss. Previous studies indicated that a weight reduction of 5% or more could induce regression of steatosis or fibrosis. However, hepatolo-gists only have time during consultations to give a short outline of the optimal lifestyle. As no data is available on the outcome of this routine practice, we evaluated the effect of this lifestyle advice on steatosis and fibrosis development among NAFLD patients. Figure: (abstract: FRI-524) The median change in clinic-laboratory parameters POSTER PRESENTATIONS S828 Journal of Hepatology 2023 vol. 78(S1) | S100-S1212 Method: Data were collected retrospectively using the electronic patient files of NAFLD patients in whom a baseline and a follow-up FibroScan® measurement (for assessment of steatosis by CAP™ and of liver stiffness (LSM) as a surrogate for fibrosis) were performed between November 2019 and 2022 at Ziekenhuis Oost-Limburg, Genk, Belgium. At the start, patients received Mediterranean diet related-advice, tips on improving exercise, and an information brochure concerning NAFLD from the hepatologist. Clinically meaningful weight loss was defined as a loss of at least 1 kg. Results: Of the 218 NAFLD patients evaluated, 130 (59.6%) were excluded due to the usage of semaglutide, not fasting, IQR/MED>30%, or bariatric surgery. In total, 88 (40.4%) patients were included, of whom 53 (60.2%) were men and 38 (43.2%) had type 2 diabetes mellitus (T2DM). The mean age, median BMI, and mean waist circumference were 54 ± 13 years, 31.0 (28.4-34.9) kg/m² and 105.2 ± 12.7 cm, respectively. On average, there were 186 (124-280) days between the measurements. The median weight loss between measurements was −1.2 (−4.1;1.4) kg. The decrease in LSM and CAP™ were −1.2 (−3.1;0.3) kPa and −7.0 (−50.5;8.8) dB/m, respectively. Within this group, 47 (53.4%) had clinically meaningful weight loss, while 41 (46.6%) did not lose any weight or gained weight. The group with weight loss developed a significantly (p < 0.001) lower CAP™ compared to baseline values, but there was no significant change in LSM during the same time period. Furthermore, within the weight loss group, there were no differences in magnitude of weight loss or CAP™ when stratified based on sex, age categories (≤50 years vs. >50 years), or having T2DM or not (p > 0.05). Conclusion: To the best of our knowledge, this is the first study to assess the effect of routine lifestyle advice by a hepatologist on body weight, steatosis, and fibrosis, measured by FibroScan®. The lifestyle advice leads to a weight reduction of at least −1 kg in almost half of NAFLD patients and a significant reduction in steatosis over six months in those patients. However, the recommended reduction in body weight (at least 5%) is not reached. Other measures to support the advice on lifestyle change given by the hepatologist are hence necessary to improve efficacy. Background and aims: Anti-obesity drugs are known to improve hepatic inflammation in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to compare the effect of liraglutide and phentermine/topiramate in obese NAFLD patients. Method: We retrospectively enrolled 65 obese NAFLD patients without type 2 diabetes mellitus (liraglutide group [n = 30], phen-termine/topiramate group [n = 35]) who were treated with liraglutide or phentermine/topiramate for 12 months. Changes in laboratory data, body weight, degree of steatosis and fibrosis were compared between two groups. Steatosis was assessed using the fatty liver index, NAFLD liver fat score, and controlled attenuation parameter (CAP). Fibrosis was assessed using fibrosis index based on four factors (FIB4) and liver stiffness. Results: The mean body weight (80.3 ± 12.3 kg) and body mass index (29.4 ± 3.2) were similar between two groups. After 12 month of treatment, phentermine/topiramate group showed significantly greater effect in weight loss than liraglutide group (−8.4 ± 0.6 vs. −6.3 ± 0.4 kg, p = 0.003). Both group showed similar effect showing significant steatosis reduction (phentermine/topiramate vs. liraglu-tide; Δfatty liver index: −8.9 ± 2.3 vs. −8.4 ± 1.7, p = 0.449; ΔNAFLD liver fat score: −0.5 ± 0.2 vs. −0.4 ± 0.2, p = 0.835; ΔCAP: −9.2 ± 6.9 vs. −8.3 ± 4.6 dB/m 2 , p = 0.129). Fibrosis improvement was noted in both