Dedicated Intervention Can Achieve Weight Loss in Patients With NALFD

Guidelines recommend patients with nonalcoholic fatty liver disease (NAFLD) who are obese achieve 5% to 10% weight loss to prevent NAFLD progression.

Weight loss is the treatment of choice to prevent nonalcoholic fatty liver disease (NAFLD) progression in patients who are obese, and a dedicated weight intervention pathway can more successfully achieve the recommended 5% to 10% weight loss than standard hepatology practice, according to a poster presented at The Liver Meeting.

Previous clinical trials for weight loss in patients with nonalcoholic steatohepatitis found 30% of patients achieved more than 5% total body weight loss (TBWL) and 10% of patients achieved more than 10% TBWL.

“Interventions can include dietary changes, behavioral modifications, physical activity, and pharmacological treatment,” explained poster author Vicki Shah, PA-C, DMSc, MMS, of Rush University, during her presentation.

The researchers embedded a weight intervention pathway led by a hepatologist and 3 advanced practice providers directly in the clinic. Between November 2018 and April 2021, 83 patients were enrolled in the Weight Loss Intervention in Liver Disease (WILD) pathway and 30 patients with NAFLD received routine general care. Patients who were included in the WILD pathway had liver disease, a body mass index above 25, and a willingness to participate.

The WILD pathway consisted of a 1-hour consultation during the initial appointment followed by monthly 30-minute appointments for 6 months. At the end, the researchers conducted a retrospective chart review to compare percent weight change.

The 83 patients on the WILD pathway attended at least 2 appointments. In the WILD pathway, 61 patients (73.5%) achieved a median TBWL of 4.48% compared with only 12 patients (40%) achieving a median TBWL of 2.95% in the routine care group. Of the 61 patients in the WILD pathway, 39.3% achieved greater than 5% TBWL and 16.4% achieved greater than 10%. In comparison, 0.14% of patients in routine care achieved greater than 5% TBWL and no patients lost more than 10%.

Furthermore, 17 patients (56.6%) in general practice had a median weight gain of 2% compared with 20 patients (21.4%) in the WILD pathway who had a median weight gain of 1.06%. Only 3 patients on the WILD pathway and 1 patient in routine care reported no weight change.

“In conclusion, an APP dedicated weight intervention pathway was more successful in achieving weight loss than the standard hepatology APP practice,” Shah said in her presentation.

She noted that a limitation of the study was the selection bias, because the patients in the intervention had to be willing to participate, and therefore, “they might be more motivated to make lifestyle interventions.”

Reference

Shah V, Repkin S, Folkers C, Fetrow L, Reau N, Janardhan S. An advanced practice provider (APP) pathway achieves more effective weight loss in NAFLD patients compared to standard of care. Presented at: The Liver Meeting; November 12-15, 2021; virtual.