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Beneficial effects of lifestyle intervention in non-obese patients with non-alcoholic fatty liver disease
Abstract
Background & aims Around 10-20% of patients with non-alcoholic fatty liver disease (NAFLD) are non-obese. The benefit of weight reduction in such patients is unclear. We aim to study the efficacy of lifestyle intervention in non-obese patients with NAFLD and to identify factors that predict treatment response.Methods A total of 154 community NAFLD patients were randomised to a 12-month lifestyle intervention programme involving regular exercise, or to standard care. The primary outcome was remission of NAFLD at Month 12 by proton-magnetic resonance spectroscopy. After the programme, the patients were prospectively followed until Year 6. The Asian body mass index (BMI) cut-off of 25 kg/m 2 was used to define non-obese NAFLD.Results Patients were assigned to the intervention (n = 77) and control (n = 77) groups (39 and 38 in each group had baseline BMI <25 and ≥25 kg/m 2, respectively). More patients in the intervention group achieved the primary outcome than the control group regardless of baseline BMI (non-obese: 67% vs. 18%, p <0.001; obese: 61% vs. 21%, p <0.001). Lifestyle intervention, lower baseline intrahepatic triglyceride, and reduction in body weight and waist circumference were independent factors associated with remission of NAFLD in non-obese patients. Half of non-obese patients achieved remission of NAFLD with 3-5% weight reduction; the same could only be achieved in obese patients with 7-10% weight reduction. By Year 6, non-obese patients in the intervention group remained more likely to maintain weight reduction and alanine aminotransferase normalisation than the control group.Conclusions Lifestyle intervention is effective in treating NAFLD in both non-obese and obese patients. Weight reduction predicts remission of NAFLD in non-obese patients, but a modest weight reduction may be sufficient in this population.Lay summary Some patients with non-alcoholic fatty liver disease (NAFLD) are non-obese. The optimal management of such patients is unclear. In this long-term follow-up study of a clinical trial, we show that remission of NAFLD can be achieved in 67% of non-obese patients after lifestyle intervention. The majority of patients can achieve NAFLD remission with modest weight loss of 3-10%. Non-obese patients are also more likely than obese patients to maintain weight reduction and normal liver enzymes in the long run.
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“In an RCT of a 12month lifestyle intervention programme, a 3-5% weight reduction led to remission of MASLD (measured by 1 H-MRS) among 50% of the individuals without obesity.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [333]
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“Moreover, individuals de fi ned as non-obese were more likely than individuals with obesity to maintain weight reduction and normal liver enzymes over long-term (6-year) follow-up. 333”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [333]
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“…MASLD tend to face a similar clinical course or ever more severe liver and non-liver complications and overall mortality than their non-lean counterparts, this section collectively summarizes the current expert consensus on how to clinically approach and manage MASLD in lean individuals [59,72,73].”
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Metadata
- Authors
- Wong, V. W.-S., Wong, G. L.-H., Chan, R. S.-M., Shu, S. S.-T., Cheung, B. H.-K., Li, L. S., Chim, A. M.-L., Chan, C. K.-M., Leung, J. K.-Y., Chu, W. C.-W., Woo, J., & Chan, H. L.-Y.
- Affiliations
- Chinese University of Hong Kong (HK)
- Corresponding author
- Chan, Henry Lik-Yuen
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 69
- Issue
- 6
- Pages
- 1349-1356
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2888552653
- Cited by
- 319
- References
- 35
- Citations by year
- 2026: 27 · 2025: 39 · 2024: 62 · 2023: 54 · 2022: 40 · 2021: 45 · 2020: 31 · 2019: 18 · 2018: 1
- FWCI
- 18.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- non-alcoholic fatty liver disease, non-obese patients, lifestyle intervention, physical activity, weight loss, intrahepatic triglyceride, waist circumference, predictors of treatment response, community-based patients, long-term follow-up, weight maintenance, 1H NMR
- MeSH terms
- Adult, Aged, Diet, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Obesity, Prospective Studies, Remission Induction, Triglycerides, Weight Loss, Exercise, Body Mass Index, Single-Blind Method, Treatment Outcome, Waist Circumference, Non-alcoholic Fatty Liver Disease
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