The Effect of Moderate Weight Loss on a Non-Invasive Biomarker of Liver Fibrosis: A Randomised Controlled Trial

Abstract

Background: Referral to weight loss programmes is the only effective treatment for nonalcoholic fatty liver disease (NAFLD). Clinicians should advise weight loss and screen for liver fibrosis using the Enhanced Liver Fibrosis (ELF) score. Aim: To examine if the ELF score changes with weight loss. Design and Setting: Randomised controlled trial (ISRCTN85485463) in UK primary care during 2007-2008. Method: Adults with a BMI of 27-35 kg/m 2 and ≥1 risk factor for obesity-related disease were randomised to attend a community weight loss programme (n = 45) or receive usual weight loss advice from a practice nurse (n = 28). Weight and the ELF score were measured at baseline and 1 year. Analysis of covariance examined mean changes in the ELF score between groups and its relationship with weight loss. Results: Mean (SD) BMI was 31.10 kg/m 2 (2.55) with evidence of moderate levels of liver fibrosis at baseline (mean ELF score: 8.93 [0.99]). There was no evidence that the community weight loss programme reduced the ELF score compared with usual care (difference +0.13 points, 95% CI: -0.25 to 0.52) despite greater weight loss (difference: -2.66 kg, 95% CI: -5.02 to -0.30). Mean weight loss in the whole cohort was 7.8% (5.9). There was no evidence of an association between weight change and change in ELF; the coefficient for a 5% weight loss was -0.15 (95% CI: -0.30 to 0.0002). Conclusion: We found no evidence that the ELF score changed meaningfully following moderate weight loss. Clinicians should not use the ELF score to measure improvements in NAFLD fibrosis following weight loss programmes.

Association of Weight Changes With Changes in Histological Features and Blood Markers in Nonalcoholic Steatohepatitis

“…10 Weight change was also positively associated with changes in FIB-4, a noninvasive fibrosis marker. Previous research found no evidence of changes in another noninvasive fibrosis marker, the Enhanced Liver Fibrosis score, following weight loss in an unselected population with overweight and possible moderate fibrosis, 26 but reductions in magnetic resonance measured liver stiffness with weight loss in NAFLD. 27 Identifying noninvasive biomarkers of NASH and fibrosis that are responsive to change is crucial for routine monitoring.…”

Noninvasive assessment of fibrosis among patients with nonalcoholic fatty liver disease [NAFLD]

“…Also, as opposed to one of the shortcomings reported for NFS testing, the results of ELF testing do not appear to fluctuate based on obesity. One randomized study has demonstrated that moderate weight loss did not affect the ELF score significantly [ 27 ].…”