Weight loss interventions might yield significant short- and medium-term improvements in biomarkers of liver disease in patients with nonalcoholic fatty liver disease (NAFLD), but long-term effects remain unclear, according to study results published in JAMA Internal Medicine.

Researchers conducted a systematic review and meta-analysis of randomized clinical trials to examine the association between weight loss interventions and blood, radiologic, and histologic biomarkers of liver disease. They included 2588 patients (mean age, 45 years) from 22 studies, 15 of which tested behavioral weight loss programs, 6 pharmacotherapy, and 1 a surgical procedure.

Median intervention duration for included studies was 6 months. Compared with interventions that were no/minimal intensity or lower intensity, more intensive weight loss interventions were significantly associated with greater weight change (-3.51 kg; I2 =95%).

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There was also a significant association between weight loss interventions and improvements in alanine aminotransferase (-9.81 U/L; I2 =97%) and other biomarkers, histologically or radiologically measured liver steatosis (standardized mean difference in weight, -1.48 kg; I2 =94%), histologic NAFLD activity score (standardized mean difference in weight, -0.92 kg; I2 =95%), and presence of nonalcoholic steatohepatitis (odds ratio, 0.14; I2 =0%). The researchers discovered no significant change in histologic liver fibrosis (-0.13; I2 =68%).

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There were 12 studies found to be at high risk for bias in at least one aspect. Following sensitivity analysis of the 3 included trials that were at low risk for bias, they discovered no significant changes in estimates and precision of most outcomes.

Study limitations included high statistical heterogeneity and the relatively short duration of most studies.

“Weight loss interventions appeared to be associated with statistically and clinically significant improvements in biomarkers of liver disease in people with NAFLD in the short term,” the researchers said. “The accumulated evidence supports changing the clinical guidelines and routine practice to recommend formal weight loss programs to treat people with NAFLD.”

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Koutoukidis DA, Astbury NM, Tudor KE, et al. Association of weight loss interventions with changes in biomarkers of nonalcoholic fatty liver disease: a systematic review and meta-analysis [published online July 1, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.2248