Reduction of Visceral Adiposity as a Predictor for Resolution of Nonalcoholic Fatty Liver in Potential Living Liver Donors

Abstract

This study aimed to determine the factors associated with resolution of nonalcoholic fatty liver (NAFL) after lifestyle intervention in potential living liver donors as assessed by the gold standards in a longitudinal setting. This retrospective study included 115 potential living liver donors (mean age, 30.5 ± 7.5 years; 101 men) with NAFL who underwent paired liver biopsies and abdominal computed tomography (CT) examinations before and after lifestyle intervention between January 2011 and December 2018. Anthropometry, laboratory parameters, body composition, and hepatic steatosis (HS) were evaluated before and after lifestyle intervention. Anthropometry, laboratory parameters, body composition, and HS were significantly decreased after lifestyle intervention (all, P < 0.001). Relative changes in HS were weakly correlated with relative changes in the visceral fat area (VFA; r = 0.278; P = 0.003) and subcutaneous fat area (r = 0.382; P < 0.001), but not with body weight, body mass index, or skeletal muscle area. Patients with resolved NAFL after lifestyle intervention had significantly lower VFA at follow-up than those with persistent NAFL (mean ± standard deviation, 69.8 ± 39.1 versus 91.5 ± 41.4 cm 2 ; P = 0.01). Multivariable logistic regression analysis demonstrated that the relative reduction of VFA (odds ratio per percent, 1.031; 95% confidence interval, 1.010-1.053; P = 0.004) was a significant independent factor associated with resolved NAFL after lifestyle intervention. In potential living liver donors with NAFL, the reduction of VFA is a significant factor associated with the resolution of NAFL after lifestyle intervention.

Improved body composition decreases the fat content in non-alcoholic fatty liver disease, a meta-analysis and systematic review of longitudinal studies

“…Based on two studies ( 19 , 20 ) with 85 patients, we found a pooled correlation coefficient of r = 0.49 (CI: 0.22–0.69, Spearman's correlation) between VAT change and liver steatosis. Similarly, based on three ( 21 , 23 , 27 ) studies with 175 patients, the correlation was r = 0.33 (0.19–0.46, Pearson's correlation, Figure 2 ).…”

“…In the multivariate Cox proportional hazard model, the risk for regressed NAFLD comparing tertiles 2 and 3 vs. tertile 1 of change in VAT area were hazard ratio (HR) = 0.70 (CI: 0.42–1.16) and HR = 0.38 (CI: 0.20–0.73), respectively. Lee et al ( 27 ) examined the effect of lifestyle interventions in living liver donors with NAFLD on the improvement of different body composition parameters and changes in steatosis. The relative reduction of the visceral fat area was the only significant independent factor associated with resolved NAFLD (odds ratio—OR = 1.03, CI: 1.01–1.05).…”

“…Based on two ( 23 , 27 ) studies with 163 patients, the correlation between SAT change and liver steatosis change was r = 0.42 (0.29–0.54, Pearson's correlation, Figure 2 ). Further details are summarized in the Supplementary Results .…”

Visceral adipose tissue and risk of nonalcoholic fatty liver disease: A Mendelian randomization study

“…A retrospective study found that NAFLD significantly resolved (less than 5% hepatic steatosis on follow-up liver biopsy) after lifestyle intervention to reduce visceral fat area. 35 In addition, weight loss helps to improve NAFLD. Bariatric surgery is an effective way to lose weight.…”

“…Another question we considered was whether reducing visceral fat would contribute to the regression of NAFLD. A retrospective study found that NAFLD significantly resolved (less than 5% hepatic steatosis on follow‐up liver biopsy) after lifestyle intervention to reduce visceral fat area 35 . In addition, weight loss helps to improve NAFLD.…”