Su1303 Long-Term Effects of an Interdisciplinary 52-Week Weight Loss Program on Adipokines and Nonalcoholic Fatty Liver Disease in Obese Patients – A Prospective Evaluation

Abstract

Background/aim: Nonalcoholic fatty liver disease (NAFLD) is considered to be the most common liver disorder in western countries, with a rising prevalence. NAFLD is strongly associated with the presence and severity of obesity, but there is to date no convincing medical therapy. Thus, weight reduction is still the first-line therapy for NAFLD patients. The aim of this study was to evaluate the efficacy of Optifast 52, a commercial interdisciplinary weight loss program, with special emphasis on the adipokines leptin and adiponectin in NAFLD patients. Methods: A total of 72 participants with a BMI of higher than 30 kg/m2 were included. Participants attended weekly over the course of 52 weeks for medical assessment, physical activity, dietary counseling and psychological support. Laboratory values were determined and bioelectrical impedance analyses (BIA) of body composition performed at baseline, and after 26 and 49 weeks. Assessment of NAFLD was carried out using noninvasive parameters: the NAFLD fibrosis score and the BARD score. Results: Of the 72 participants, 42 completed the Optifast program. Initial weight was reduced significantly from 121.1(± 24)kg to 96.3(± 21.9)kg (p=0.0005). Thus, BMI fell from 41.3(± 6.9)kg/m2 to 32.8(± 6.5)kg/m2 and fat mass was reduced from an initial 54.5(± 13.3)kg to 35(± 13.2)kg. The AST/ALT ratio improved with weight loss from 1.17(± 0.5) to 0.83(± 0.26). At baseline, 69% of patients were found to have a pathological AST/ALT ratio, compared to only 24.1% at week 49. The NAFLD score improved from -0.11(± 1.3) to -1.1(± 1.3) on study completion, where a score of -1,455 indicates that liver fibrosis can be excluded. Thus, at the beginning of the study, 14.3% of participants were at low risk of fibrosis, while 28.6% were at high risk. This changed to 39.3% and 3.6% at week 49, respectively. The BARD score improved significantly from 3.5(± 0.87) (baseline) to 2.6(± 1.1) (week 49), coincidentally with an improvement of the leptin/adiponectin ratio from initial 1.16(±0.96) to 0.31(±0.25) (p=0.0005). Conclusion: These data clearly demonstrate the Optifast 52 interdisciplinary weight reduction program to effectively reduce not only liver parameters, but also scores for estimating NAFLD in obese patients. There is evidence in these data that especially the combination of weight reduction through diet and activity has a positive impact on the leptin/adiponectin ratio. As long as no medication is available for this purpose, weight reduction in the form of an interdisciplinary weight management program is therefore a suitable therapy for NAFLD.