Obesity management in liver clinics: Translation of research into clinical practice

Osland, Emma; Powell, Elizabeth E.; Banks, Merrilyn; Jonsson, Julie R.; Hickman, Ingrid J.

doi:10.1111/j.1440-1746.2006.04830.x

Cited by 26 publications

(20 citation statements)

References 20 publications

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“…The association between NAFLD and MS was the reason why we tested CBT in our patients, and the results were consistent with those in other associated conditions. Our study lends support to a seminal experience in a general population of obese subjects with liver disease (29), where CBT showed beneficial effects on liver enzymes.…”

Section: Discussionsupporting

confidence: 82%

Cognitive‐Behavioral Treatment of Nonalcoholic Fatty Liver Disease: A Propensity Score‐Adjusted Observational Study

Moscatiello

Luzio

Bugianesi

et al. 2011

Obesity

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The effectiveness of cognitive‐behavior treatment (CBT) in nonalcoholic fatty liver disease (NAFLD), largely related to overweight/obesity and considered the hepatic expression of the metabolic syndrome (MS), has so far been tested in very limited samples. In a tertiary referral center, consecutively observed NAFLD subjects were offered a CBT program aimed at weight loss and increased physical activity, based on 13 group sessions; 68 cases entered the treatment protocol, those who refused (n = 82) were given recommendations for diet and physical activity. Treatment goals (weight loss ≥7% initial body weight, normalization of liver enzymes, and improved parameters of MS) were tested by logistic regression at 6 months (all cases) and at 2 years, both on intention‐to‐treat and in completers (Diet, 78; CBT, 65). The results were adjusted for the propensity score of attending the CBT program, based on civil, anthropometric and clinical variables. At baseline the CBT group had a larger prevalence of obesity and more severe insulin resistance (homeostasis model assessment (HOMA)). At follow‐up, CBT was associated with a higher probability of weight loss and normal liver enzymes (6‐month: odds ratio (OR), 2.56; 95% confidence interval (CI), 1.15–5.69; 2‐year intention‐to‐treat: OR, 3.57, 95% CI, 1.59–8.00), after adjustment for propensity and changes in body weight. A similar trend was observed in the outcome goals of insulin resistance and the score of MS, which were both reduced. In conclusion, subjects with NAFLD participating in a CBT program significantly improve their general and liver parameters. The beneficial effects are largely maintained at 2‐year follow‐up, in keeping with the lifestyle‐related pathogenesis of disease.

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Section: Discussionsupporting

confidence: 82%

Cognitive‐Behavioral Treatment of Nonalcoholic Fatty Liver Disease: A Propensity Score‐Adjusted Observational Study

Moscatiello

Luzio

Bugianesi

et al. 2011

Obesity

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“…This study in ‘office’ patients with metabolic liver disease is the first to demonstrate significant positive health effects at 3 months on liver enzymes and other metabolic risk factors using a low intensity, practical lifestyle intervention based on behavior‐change theory. The study is unique for the large sample size and the use of a control group 23 . The multi‐disciplinary behavior change intervention was theoretically grounded and aimed to replace the dose (number of consultations), with quality of contact, thus testing a practical and pragmatic intervention model.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have demonstrated improvements in liver histology in patients with liver disease through weight loss achieved by dietary counselling 16–23 . Limitations of previous reports include small sample sizes ( n = 14–50), 16,18,19,23 absence of control groups, 16,17,23,24 use of very specific patient groups, 16,17,20 intensive interventions 18,23,24 and the use of prescriptive dietary counselling and intensive structured interventions, aimed primarily at achieving weight loss rather than long‐term lifestyle change 16–18,20,23,24 . While these studies provide support for the use of lifestyle interventions in patients with liver disease, questions remain on the optimal type and intensity of the intervention that needs to be provided and the minimum amount of weight loss required to achieve metabolic benefits 25 …”

Section: Introductionmentioning

confidence: 99%

Effect of a lifestyle intervention in patients with abnormal liver enzymes and metabolic risk factors

St.George

Bauman

Johnston

et al. 2009

J of Gastro and Hepatol

102

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Background and Aim: Non-alcoholic fatty liver disease associated with insulin resistance is the most common cause of abnormal liver tests in clinical practice. To date, practical and effective strategies to improve the metabolic profile of this large group of patients have not been well characterised. We sought to assess the effect at 3 months of a behavior changebased lifestyle intervention on the metabolic profile of patients characterised by elevated liver enzymes. Methods: A total of 152 patients with elevated liver enzymes, central obesity and a range of metabolic risk factors were randomised to either a moderate-(6 sessions/10 weeks) or low-intensity (3 sessions/4 weeks) lifestyle counselling intervention or control group. Results: There was improvement in all metabolic risk factors in the moderate-intensity group, versus a smaller number of changes in the low-intensity intervention group and no change in any metabolic risk factors in control subjects. Reduction in liver enzymes was greatest in the moderate-intensity intervention group and least in the control group. The likelihood of elevated alanine aminotransferase (ALT) levels in both the moderate and low-intensity groups was reduced by over 70% compared to controls. The proportion of subjects achieving weight loss (Ն 2%) was significantly higher in the moderate-intensity intervention group (66%) versus the low-intensity intervention group (39%; P < 0.05) and controls (29%; P < 0.001). Conclusions: Moderate and even low-intensity lifestyle counselling interventions targeting improvement in physical activity and nutritional behaviors and modest weight loss are a practical and effective method for improving the health of patients with elevated liver enzymes and a range of metabolic risk factors.

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“…On the other hand, the efficacy of lifestyle measures or bariatric surgery to improve fatty liver disease was strongly endorsed. This is based on a growing body of evidence to base this assertion, 57,153–157 to which Australians have contributed substantially.…”

Section: What Should Be the Basis Of Management?mentioning

confidence: 99%

The liver and the waistline: Fifty years of growth

Farrell

2009

J of Gastro and Hepatol

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Fifty years of the Gastroenterological Society of Australia have witnessed the changing appearance of Australians. Asian immigration has transformed the dominant urban culture from European to Eurasian, with some unique Australian attributes. Meanwhile, global conditions have altered body shape, and our sports-proud country is now fat! Thus, as in North America, Europe, China, and affluent Asia-Pacific countries, prosperity and lifestyle, cheap processed foods coupled with reduced physical activity have created an epidemic of over-nutrition resulting in overweight/obesity. Additional genetic factors are at the core of the apple shape (central obesity) that typifies over-nourished persons with metabolic syndrome. Indigenous Australians, once the leanest and fittest humans, now have exceedingly high rates of obesity and type 2 diabetes, contributing to shorter life expectancy; Asian Australians are also at higher risk. Like non-steroidal anti-inflammatory drugs (NSAIDs) and cigarette smoking, obesity now contributes much to gastrointestinal morbidity and mortality (gastroesophageal reflux disease, cancers, gallstones, endoscopy complications). This review focuses on Australian research about fatty liver, particularly roles of central obesity/insulin resistance in non-alcoholic fatty liver disease/steatohepatitis (NAFLD/NASH). The outputs include many highly cited original articles and reviews and the first book on NAFLD. Studies have identified community prevalence, clinical outcomes, association with insulin resistance, metabolic syndrome and hypoadiponectinemia, developed and explored animal models for mechanisms of inflammation and fibrosis, conceptualized etiopathogenesis, and demonstrated that NASH can be reversed by lowering body weight and increasing physical activity. The findings have led to development of regional guidelines on NAFLD, the first internationally, and should now inform daily practice of gastroenterologists.

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Obesity management in liver clinics: Translation of research into clinical practice

Cited by 26 publications

References 20 publications

Cognitive‐Behavioral Treatment of Nonalcoholic Fatty Liver Disease: A Propensity Score‐Adjusted Observational Study

Cognitive‐Behavioral Treatment of Nonalcoholic Fatty Liver Disease: A Propensity Score‐Adjusted Observational Study

Effect of a lifestyle intervention in patients with abnormal liver enzymes and metabolic risk factors

The liver and the waistline: Fifty years of growth

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