Feasibility of a Very Low Calorie Diet to Achieve a Sustainable 10% Weight Loss in Patients With Nonalcoholic Fatty Liver Disease

Abstract

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is the most common liver condition worldwide. A weight loss goal of ≥10% is the recommended treatment for NAFLD; however, only a minority of patients achieve this level of weight reduction with standard dietary approaches. This study aimed to determine whether a very low calorie diet (VLCD) is an acceptable and feasible therapy to achieve and maintain a ≥10% weight loss in patients with clinically significant NAFLD. METHODS: Patients with clinically significant NAFLD were recruited to a VLCD (∼800 kcal/d) intervention using meal replacement products. Anthropometrics, blood tests (liver and metabolic), liver stiffness, and cardiovascular disease risk were measured at baseline, post-VLCD, and at 9-month follow-up. RESULTS: A total of 45 patients were approached of which 30 were enrolled 27 (90%) completed the VLCD intervention, and 20 (67%) were retained at 9-month follow-up. The VLCD was acceptable to patients and feasible to deliver. Intention-to-treat analysis found that 34% of patients achieved and sustained ≥10% weight loss, 51% achieved ≥7% weight loss, and 68% achieved ≥5% weight loss at 9-month follow-up. For those completing the VLCD, liver health (liver enzymes and liver stiffness), cardiovascular disease risk (blood pressure and QRISK2), metabolic health (fasting glucose, HbA1c, and insulin), and body composition significantly improved post-VLCD and was maintained at 9 months. DISCUSSION: VLCD offers a feasible treatment option for some patients with NAFLD to enable a sustainable ≥10%, weight loss, which can improve liver health, cardiovascular risk, and quality of life in those completing the intervention.

Factors associated with engagement and adherence to a low-energy diet to promote 10% weight loss in patients with clinically significant non-alcoholic fatty liver disease

“…These baseline characteristics closely matched those of the whole sample of patients taking part in the LED feasibility study, as confirmed by statistical analysis, showing good representation. 13 The qualitative data collected from patients who took part in the LED intervention generated six themes and four subthemes that highlighted a number of factors associated with uptake, engagement and adherence. A summary of themes and subthemes is presented as figure 1, and table 2 presents a narrative summary of findings in relation to each theme and subtheme.…”

“…12 Despite the LED approach being used to actively reduce liver volume and fat prior to bariatric surgery since 2004, it had never been formally assessed as a treatment strategy for NAFLD until recently. [13][14][15] Our study assessed the acceptability and feasibility of delivering a LED to patients with clinically significant NAFLD and found that it is a potential treatment option, with 34% of patients maintaining >10% weight loss at 9-month follow-up and 51% and 68% maintaining >7% and >5%, respectively. 13 A recent systematic review synthesised qualitative studies investigating participants' experiences of undertaking a Very low energy diet (VLED) achieved using total meal replacement products.…”

“…[13][14][15] Our study assessed the acceptability and feasibility of delivering a LED to patients with clinically significant NAFLD and found that it is a potential treatment option, with 34% of patients maintaining >10% weight loss at 9-month follow-up and 51% and 68% maintaining >7% and >5%, respectively. 13 A recent systematic review synthesised qualitative studies investigating participants' experiences of undertaking a Very low energy diet (VLED) achieved using total meal replacement products. The authors reported that VLEDs are well accepted by users and motivations to uptake included health-related outcomes and body image/appearance.…”

“…Semistructured one-to-one interviews were conducted immediately following completion of the 8-12-week LED (n=23). 13 All patients who completed the LED…”

Effective Treatment of Nonalcoholic Fatty Liver Disease Using a Community-Based Weight Management Program

“…The effectiveness of multifaceted behavioral weight management programs has been widely described in the literature [18][19][20][21]. However, much of the available evidence is derived from clinical trials that are conducted in a controlled setting under the supervision of experienced researchers at academic institutions.…”