Weight Loss and Weight Regain in Usual Clinical Practice: Results From the TARGET-NASH Observational Cohort

Malespin, Miguel; Barritt, A. Sidney; Watkins, Stephanie; Schoen, Cheryl; Tincopa, Monica A.; Corbin, Karen D.; Mospan, Andrea R.; Muñoz, Breda; Trinh, Huy N.; Weiss, Laurence; Reddy, K. Rajender; Loomba, Rohit; Kemmer, Nyingi; Lok, Anna S.

doi:10.1016/j.cgh.2021.01.023

Cited by 30 publications

(42 citation statements)

References 8 publications

(1 reference statement)

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“…Our study is consistent with the literature and demonstrates the effectiveness of a gastroenterologist-supervised weight management program that can be implemented at a community-based level and conducted by healthcare personnel in everyday routine practice. A recent study conducted by Malespin et al found that only 32% of overweight or obese adults with NAFLD receiving usual care in the US achieved ≥5% TBW loss during a median follow-up of 39 months [ 29 ]. Therefore, the ability of our program to achieve a 10% TBW loss in 65% of patients who presented for their three-month follow-up office visit is encouraging, not to mention the additional benefits of the program demonstrated by the improvement in GERD and T2DM disease status in 52% and 38% of patients with these conditions, respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Hawa

Gladshteyn

Gunaratnam

et al. 2021

Cureus

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IntroductionObesity-related gastrointestinal disorders including nonalcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) are more frequent and usually present earlier than type 2 diabetes mellitus (T2DM) and cardiovascular disorders. This provides an opportunity for the gastroenterologist to intervene early with an effective weight-loss therapy. We evaluated the outcomes of a multifaceted, community-based gastroenterologist-supervised weight management program compared with patientdirected weight-loss efforts after physician advice. The program is aimed at achieving a 10% total body weight (TBW) loss at three months, a known determinant for NAFLD regression. MethodsThis is a retrospective pre-and post-intervention study of NAFLD patients, who participated in a medically supervised weight management program in the period between May 2017 and May 2019. The program is comprised of a very-low-calorie (800 kcal/day) meal replacement diet, a recommended medical fitness program, and weekly behavioral support groups. Patients are followed on monthly basis and slowly transitioned to a whole food plant-based or Mediterranean diet after three months of participation. Patients' weight trends driven by self-directed efforts to lose weight after physician advice were collected based on historical data up to two years prior to program participation. The primary outcome was defined as percentage TBW loss at three months under medical supervision (post-intervention) compared with patientdirected weight-loss efforts (pre-intervention). The secondary outcomes included percentage TBW loss in relation to behavioral support group attendance and improvement in GERD and T2DM disease status after program participation. Linear mixed and linear regression models were used to assess for a statistically significant difference in percentage TBW loss. Statistical significance was defined as p < 0.05. ResultsA total of 114 NAFLD patients (mean age 55 years, mean BMI 39 kg/m 2 , 77 females, and 37 males) completed at least three months of follow-up and were included in the study. Of those, 89 patients had a documented three-month office visit. At three months, 65% of patients had lost at least 10% of their TBW. Percentage TBW loss under medical supervision was noted to be significantly higher and occurred at a faster rate over three months when compared with patient-directed efforts after physician advice (p < 0.001). Patients who attended the behavioral support groups ≥ 50% of the time had a 3% higher TBW loss at three months compared with patients who attended <50% of the time (p = 0.006). Approximately, 52% of patients with GERD and 38% of patients with T2DM had symptoms improvement and/or medication reduction at their three-month follow-up visit. ConclusionA multifaceted, community-based, gastroenterologist supervised weight management program is effective in achieving a clinically significant TBW loss of at least 10% within three months of participation. This weight loss was greater and occurred at a faster rate ...

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Section: Discussionmentioning

confidence: 99%

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

Hawa

Gladshteyn

Gunaratnam

et al. 2021

Cureus

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“…A major limitation of all lifestyle modification programs is non-compliance and the inability to sustain weight loss beyond the prescribed program. Indeed, fewer than half of the patients undergoing lifestyle intervention programs achieved the targeted weight loss, and only 25% of the patients managed to sustain the weight loss of > 5% [ 47 ]. As such, there is increased efforts in developing new pharmacological treatment for NAFLD.…”

Section: Therapeuticsmentioning

confidence: 99%

A Review of the Epidemiology, Pathophysiology, and Efficacy of Anti-diabetic Drugs Used in the Treatment of Nonalcoholic Fatty Liver Disease

et al. 2021

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In recent years, epidemiological studies have consistently demonstrated that the coexistence of nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) is strongly associated with increased mortality and morbidity related to hepatic- and extrahepatic causes. Indeed, compared with the general population, patients with T2DM are more likely to be diagnosed with more severe forms of NAFLD (i.e., nonalcoholic steatohepatitis (NASH) with liver fibrosis). There is an ongoing debate whether NALFD is a consequence of diabetes or whether NAFLD is simply a component and manifestation of the metabolic syndrome, since liver fat (steatosis) and even more advanced stages of liver fibrosis can occur in the absence of diabetes. Nevertheless, insulin resistance is a key component of the mechanism of NAFLD development; furthermore, therapies that lower blood glucose concentrations also appear to be effective in the treatment of NAFLD. Here, we will discuss the pathophysiological and epidemiological associations between NAFLD and T2DM. We will also review currently available anti-diabetic agents with their regard to their efficacy of NAFLD/NASH treatment.

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“…Clinical information, including demographics, comorbidities, concomitant medications, laboratory results, pathology reports and imaging data, is abstracted from the electronic medical records for a period of up to 3 years prior to enrolment and for up to 5 years prospectively, as previously described. [16][17][18][19][20] Institutional Review Board Approval was obtained for each study site prior to enrolment and all enrolled participants provided written informed consent.…”

Section: Target-nash Cohortmentioning

confidence: 99%

“…Once enrolled into TARGET-NASH, patients are classified via biopsy and/or clinical criteria as having non-alcoholic fatty liver (NAFL), NASH or cirrhosis due to NAFLD as previously described. [16][17][18][19][20] NASH is defined by the presence of steatosis, ballooning and inflammation, with or without fibrosis, based on histologic interpretation. 6 A pragmatic clinical diagnosis of NASH was created by a panel of NASH experts and is based on an elevated ALT (>19 IU/L for women and >30 IU/L for men), hepatic steatosis on biopsy or imaging and at least one of the following: BMI ≥30 kg/m 2 , type 2 diabetes mellitus (HbA1c >6.5% or identified by review of the patient's medical history) or dyslipidaemia (identified by review of the patient's medical history).…”

Section: Nafld Definitions and Severitymentioning

confidence: 99%

Liver biopsy in the real world—reporting, expert concordance and correlation with a pragmatic clinical diagnosis

Kim

Idowu

Mospan

et al. 2021

Aliment Pharmacol Ther

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Weight Loss and Weight Regain in Usual Clinical Practice: Results From the TARGET-NASH Observational Cohort

Cited by 30 publications

References 8 publications

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

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

A Review of the Epidemiology, Pathophysiology, and Efficacy of Anti-diabetic Drugs Used in the Treatment of Nonalcoholic Fatty Liver Disease

Liver biopsy in the real world—reporting, expert concordance and correlation with a pragmatic clinical diagnosis

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