S1016 Tolerance and Safety of Meal Replacement Program in Nonalcoholic Steatohepatitis With Fibrosis and Cirrhosis: A Case Series

Abstract

INTRODUCTION: Cirrhosis is associated with hypoalbuminemia, sarcopenia, and nutritional deficiencies. Yet excess weight and obesity contribute to liver disease through nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH). Medical weight loss treatments can lead to adverse effects in those with fibrosis and cirrhosis. We aimed to characterize the safety and tolerance of a meal replacement program (Optifast®) as treatment for obesity for patients with this chronic liver disease. METHODS: The Yale Fatty Liver Disease Program provides comprehensive hepatology and metabolic care, including the Optifast® meal replacement program, an 18-week (12 weeks complete followed by 6 weeks partial) program administered by dietitians and clinicians. We extracted data on patient demographics, liver disease characteristics, and metabolic outcomes. RESULTS: Data was extracted from 5 Caucasian patients with NASH, with mean age 66.6 ± 9.2 years, starting the Optifast® program and not on weight loss medications. Of these, 4 had cirrhosis, and 2 had decompensated disease (ascites and edema) and average mean MELD score 11.9 (Table 1). All patients had at least 2 associated comorbid metabolic diseases and reported improvement. At time of program completion, patients lost between 5.5 and 43.6 lbs (3.1 to 20.8% total body weight loss), with improvement in hemoglobin A1c and total cholesterol (Table 2). During meal replacement, no patients developed new clinical decompensation nor deterioration of existing decompensation. No patient regained weight during the maintenance phase. CONCLUSION: A meal replacement program using the Optifast® program was well-tolerated and did not result in worsening clinical liver disease. Despite program non-completion by some patients, improved metabolic markers were observed in all and discontinuation was not due to liver-related nor medical complication. Meal replacement for weight loss should be further explored in patients with cirrhosis given the limited treatments available for obesity in those with advanced liver disease.Table 1.: Clinical Characteristics of Patients with Nonalcoholic Steatohepatitis Starting Meal Replacement ProgramTable 2.: Outcomes of Patients with Nonalcoholic Steatohepatitis After Meal Replacement Program