Effect of weight reduction on histological activity and fibrosis of lean nonalcoholic steatohepatitis patient

Abstract

Background and Objectives Weight reduction has evidenced benefit on attenuation of histological activity and fibrosis of nonalcoholic steatohepatitis (NASH), but there is scarcity of data for lean NASH subgroup. We have designed this study to compare the effects of weight reduction on histological activity and fibrosis of lean and non-lean NASH. Methods We have included 20 lean and 20 non-lean histologically proven NASH patients. BMI < 25 kg/m2 was defined as non-lean. Informed consent was taken from each subject. All methods were carried out in accordance with the Declaration of Helsinki. Moderate exercise along with dietary restriction was advised for both groups for weight reduction. After 1 year, 16 non-lean and 15 lean had completed second liver biopsy. Results Age, sex, alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltrasferase (GGT), Homeostasis model assessment insulin resistance (HOMA-IR), triglyceride and high density lipoprotein (HDL) was similar in both groups. Steatosis, ballooning, lobular inflammation, nonalcoholic fatty liver disease activity score (NAS) and fibrosis was similar in the two groups. In lean/non-lean group, any amount of weight reduction, ≥ 5% weight reduction and ≥ 7% weight reduction was found in respectively 8/11, 5/6 and 2/6 patients. In both lean and non-lean groups, weight reduction of any amount was associated with significant reduction of steatosis, ballooning and NAS, except lobular inflammation and fibrosis. In both groups, weight reduction of ≥ 5% was associated with significant reduction in NAS only. However, significant improvement in NAS was noted with ≥ 7% weight reduction in non-lean group only. Conclusion Smaller amount of weight reduction had the good benefit of improvement in all the segments of histological activity in both lean and non-lean NASH.

The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease

“…Similar findings were observed in a study from Turkey where 5% body weight loss induced MAFLD remission in both obese and lean patients with MAFLD [288]. Similarly, a small biopsy-based study revealed that 5% weight reduction is associated with improvement of steatohepatitis in non-obese patients, similar to that which is observed in obese patients [289]. Larger biopsy-based studies are required to confirm the findings.…”

Risk factors of nonalcoholic fatty liver disease in lean body mass population: A systematic review and meta‐analysis

“…13,30,31,40,45 Eight studies were of Caucasian origin 11,17,30,31,38,39,44,45 and 14 studies were of East-Asian origin. 11,12,16,17,28,29,[32][33][34][36][37][38][39][41][42][43][44] Two studies 4,6 presented values as median (range), five studies [14][15][16]19,21 presented as median (IQR), and rest of the studies [1][2][3]5,[7][8][9][10][11][12][13]17,18,20,22 presented...…”

“…For example: successful weight reduction strategy has potential benefits in nonlean patients but there are limited benefits in lean NAFLD patients. 21 Based on the previous literature and considering the differences in the underlying mechanisms of lean and nonlean NAFLD, we hypothesized that risks factors of NAFLD might differ between those groups and needs to be assessed. Therefore, the aim of this study was to systematically evaluate the risk factors of lean NAFLD and to aid in management strategies for the prevention and control of NAFLD and related diseases.…”

Nonalcoholic fatty liver disease in lean subjects: is it all metabolic-associated fatty liver disease?

“…The concept that everyone has their own personal fat threshold [52] suggests that weight loss decreasing adiposity below the fat threshold might be beneficial metabolically and to the liver. In fact, in a small study with 20 lean-NAFLD patients, any weight loss was associated with steatosis improvement, and being above 5% corporal weight was associated with improvement in NAFLD activity score [168] .…”