Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: the SportDiet study
Open accessAbstract
Obesity increases the risk of clinical decompensation in cirrhosis, possibly by increasing portal pressure. Whether weight reduction can be safely achieved through lifestyle (LS) changes (diet and exercise) in overweight/obese patients with cirrhosis, and if weight loss reduces portal pressure in this setting, is unknown. This prospective, multicentric, uncontrolled pilot study enrolled patients with compensated cirrhosis, portal hypertension (hepatic venous pressure gradient [HVPG] ≥6 mm Hg), and body mass index (BMI) ≥26 kg/m 2 in an intensive 16‐week LS intervention program (personalized hypocaloric normoproteic diet and 60 min/wk of supervised physical activity). We measured HVPG, body weight (BW) and composition, adipokines, health‐related quality of life, and safety data before and after the intervention. Changes in HVPG and BW were predefined as clinically relevant if ≥10% and ≥5%, respectively. Safety and BW were reassessed after 6 months. 60 patients were included and 50 completed the study (56 ± 8 years old; 62% male; nonalcoholic steatohepatitis etiology 24%; BMI 33.3 ± 3.2 kg/m 2 ; Child A 92%; HVPG ≥10 mm Hg, 72%). LS intervention significantly decreased BW (average, –5.0 ± 4.0 kg; P < 0.0001), by ≥5% in 52% and ≥10% in 16%. HVPG also significantly decreased (from 13.9 ± 5.6 to 12.3 ± 5.2 mm Hg; P < 0.0001), by ≥10% in 42% and ≥20% in 24%. A ≥10% BW loss was associated with a greater decrease in HVPG (–23.7 ± 19.9% vs. –8.2 ± 16.6%; P = 0.024). No episodes of clinical decompensation occurred. Weight loss achieved at 16 weeks was maintained at 6 months; Child and Model for End‐Stage Liver Disease scores did not change. Conclusion : Sixteen weeks of diet and moderate exercise were safe and reduced BW and portal pressure in overweight/obese patients with cirrhosis and portal hypertension. (H epatology 2017;65:1293‐1305).
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In individuals with compensated cirrhosis and obesity, a reduction in body weight through lifestyle interventions, including moderate caloric restriction and supervised moderate-intensity physical exercise, has been shown to reduce portal pressure and may prevent clinical decompensation.
“In individuals with compensated cirrhosis and obesity, a reduction in body weight through lifestyle interventions, including moderate caloric restriction and supervised moderate-intensity physical exercise, has been shown to reduce portal pressure and may prevent clinical decompensation.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [455]
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Experimental — accuracy not yet measuredNo episode of clinical decompensation occurred during the 16-week diet and exercise intervention in compensated cirrhosis with portal hypertension.
“no episode of clinical decompensation occurred during the intervention [32].”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [32]
In compensated cirrhosis with portal hypertension and BMI >26, an intervention of hypocaloric diet and 60 min/week supervised physical activity significantly decreased the degree of portal hypertension after 16 weeks.
“a study investigating an intervention consisting of a hypocaloric diet and 60 min/week supervised physical activity in compensated cirrhosis with portal hypertension and a BMI >26 showed a significant decrease in the degree of portal hypertension after 16 weeks of intervention [32]”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [32]
In that same study, weight loss of >10% was associated with an even greater decrease in portal pressure.
“with a weight‐loss of >10% being associated with an even greater decrease in portal pressure.”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [32]
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- Authors
- Berzigotti, A., Albillos, A., Villanueva, C., Genescá, J., Ardevol, A., Augustín, S., Calleja, J. L., Bañares, R., García‐Pagán, J. C., Mesonero, F., Bosch, J., & on behalf of the Ciberehd SportDiet Collaborative Group
- Affiliations
- University of Bern (CH)
- CIBERehd,Instituto de Salud Carlos III,Madrid,Spain
- Instituto de Salud Carlos III (ES)
- Corresponding author
- Berzigotti, Annalisa
- ORCID
- Venue
- Hepatology
- Published
- 2017-03-06
- Volume
- 65
- Issue
- 4
- Pages
- 1293-1305
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W2566427467
- Cited by
- 334
- References
- 25
- Citations by year
- 2026: 25 · 2025: 35 · 2024: 33 · 2023: 54 · 2022: 31 · 2021: 39 · 2020: 26 · 2019: 44 · 2018: 26 · 2017: 17 · 2016: 3
- FWCI
- 21.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (acceptedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
- Open Access CRIS of the University of Bern
- Funders
- publish.illinois.edu (PIE 14/00031)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
- Instituto de Salud Carlos III (PIE 14/00031)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- portal hypertension, liver cirrhosis, obesity, lifestyle intervention, weight loss, hypocaloric diet, physical activity, hepatic venous pressure gradient, nonalcoholic steatohepatitis, clinical decompensation, adipokines, health-related quality of life, weight loss maintenance, MELD score, Child-Pugh score
- MeSH terms
- Diet, Healthy, Body Composition, Combined Modality Therapy, Female, Humans, Hypertension, Portal, Life Style, Liver Cirrhosis, Male, Middle Aged, Obesity, Pilot Projects, Prognosis, Prospective Studies, Weight Loss, Exercise, Comorbidity, Body Mass Index, Treatment Outcome, Risk Assessment
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