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Cited by 6Liver Disease Diagnosis and TreatmentDiabetes, Cardiovascular Risks, and LipoproteinsBariatric Surgery and Outcomes

Clinical utility of liver function tests for resolution of metabolic dysfunction-associated steatotic liver disease after weight loss in the Diabetes Remission Clinical Trial

Open access
Zhyzhneuskaya, S. V., Al‐Mrabeh, A. H., Peters, C., Barnes, A. C., Hollingsworth, K. G., Welsh, P., Sattar, N., Lean, M. E. J. +1 more·2025·Diabetic Medicine
DOI 10.1111/dme.15462PMC PMC11823348
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Abstract

Aims: Ectopic fat is reduced by effective weight management, but difficult to assess clinically. Methods: We evaluated paired data on 42 participants in the intervention group of the Diabetes Remission Clinical Trial (DiRECT) at baseline, 12 and 24 months after weight loss as indicators of liver fat content measured by 3‐point Dixon MRI. Results: Baseline liver fat was elevated at 13.0 [7.8–23.3]% with fasting plasma glucose 7.9 [7.1–10.1] mmol/L. Prevalence of baseline MASLD was 86.4%. After weight loss of 11.9 ± 1.2 kg (0–37 kg) at 12 months, remission of MASLD occurred in 74% and liver fat normalised for many (1.8 [1.2–5.2]%; p < 0.0001) as did fasting glucose (5.9 [5.5–7.2] mmol/L; p < 0.0001). Alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) decreased at 12 months by 38 [19–60]% (p < 0·0001) and 38 [16–53]% (p < 0.0001) respectively. The positive predictive value for decrease in liver fat, with baseline values of >40 IU/L, was 100% for ALT and 87.5% for GGT. As expected, change in liver fat correlated with change in ALT (r = 0.64; p < 0.0001), GGT (r = 0.38; p = 0.013), AST (r = 0.36; p = 0.018), fatty liver index (r = 0.50; p < 0.0001) and hepatic steatosis index (r = 0.44; p < 0.0001). Conclusion: Metabolic dysfunction‐associated steatotic liver disease, an important marker of ill‐health is improved by intentional weight loss. If enzyme levels are raised at baseline, following weight loss, changes in ALT and GGT usefully reflect change in liver fat content, with high positive predictive value. Monitoring liver enzymes can provide a simple way to assess change in liver fat following weight loss in day‐to‐day clinical practice.

AI snapshot

Written from the paper’s full text.

TL;DR

In the DiRECT intervention subgroup, substantial dietary weight loss reduced liver fat and induced MASLD remission in 74% of those with baseline MASLD at 12 months. Sequential decreases in ALT and GGT predicted normalisation of liver fat when baseline enzyme levels were raised, suggesting a simple clinical way to monitor liver fat change after weight loss.

Key findings

  • Baseline liver fat was 13.0 [7.8–23.3]% and baseline MASLD prevalence was 86.4% (51/59). After 11.9 ± 1.2 kg weight loss at 12 months, liver fat fell to 1.8 [1.2–5.2]% (p < 0.0001), and MASLD remission occurred in 26/35 (74.3%) with baseline MASLD, or 26/42 (61.9%) of the whole group; at 24 months remission persisted in 14/35 (40%) or 14/42 (33.3%).
  • ALT decreased by 38 [19–60]% and GGT by 38 [16–53]% at 12 months (both p < 0.0001). Change in liver fat correlated with change in ALT (r = 0.64; p < 0.0001), GGT (r = 0.38; p = 0.013), AST (r = 0.36; p = 0.018), fatty liver index (r = 0.50; p < 0.0001) and hepatic steatosis index (r = 0.44; p < 0.0001).
  • For baseline ALT >40 IU/L, the positive predictive value for normalisation of liver fat after weight loss at 12 months was 100%; for GGT >40 IU/L it was 87.5%, while the optimal GGT threshold >35 IU/L gave a PPV of 92.3%. In the whole type 2 diabetes group, decreases in ALT and GGT had PPVs of 75.0% and 90.0%, respectively.
  • The hepatic steatosis index decreased from 43.2 ± 0.8 at baseline to 39.7 ± 0.8 at 12 months (p < 0.0001). The BARD fibrosis score was unchanged at 12 months but improved at 24 months (2.4 ± 0.2; p = 0.041).

Methods

  • Exploratory post-hoc analysis of the Tyneside cohort of the Diabetes Remission Clinical Trial (DiRECT) intervention group. Paired liver fat and liver function test data were available for 42 participants at baseline, 12 and 24 months; baseline liver fat and LFT data were available for 59 participants. A non-diabetic control group (n = 25) was matched for post-weight-loss weight and BMI, age and sex.
  • Participants followed an integrated weight management programme: 12–20 weeks on an 825–853 kcal/day liquid formula diet, 4–6 weeks of food reintroduction, then food-based weight maintenance. Liver fat was measured by 3-point Dixon MRI; ALT, GGT, AST, fasting glucose, HbA1c and derived indices were measured.
  • Analyses used SPSS with paired/independent t-tests, Wilcoxon, Mann–Whitney, Pearson/Spearman correlations and ANOVA; correction for multiple testing was not done. PPVs of ALT and GGT for normalisation of liver fat (<5.6%) post weight loss were calculated in the diabetes group at 12 months.

Limitations

  • The paper states that the intensive diet intervention and primary care setting precluded liver biopsies to confirm relationships with hepatocyte ballooning, liver inflammation or fibrosis; LFTs were not measured immediately after the 3–5-month maximum weight-loss period; participants were typically white European ethnicity with mean BMI 34.9 kg/m², so relationships may not apply to other ethnicities; and known alcohol or substance abuse was excluded, though undeclared prior high consumption cannot be ruled out.
  • Evident from the text: this is a small exploratory post-hoc subgroup analysis (n = 42 paired data), with no correction for multiple testing, and the PPV thresholds were derived in the same cohort without external validation.
  • Evident from the text: weight regain occurred by 24 months, with MASLD prevalence rising from 21.4% at 12 months to 54.8% at 24 months, which limits conclusions about durability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/dme.15462

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 7 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Change in liver fat correlated with change in GGT (r = 0.38; p = 0.013).

    “As expected, change in liver fat correlated with change in ALT (r = 0.64; p < 0.0001), GGT (r = 0.38; p = 0.013), AST (r = 0.36; p = 0.018), fatty liver index (r = 0.50; p < 0.0001) and hepatic steatosis index (r = 0.44; p < 0.0001).”
    • Also stated in: § Liver enzymes · plain
      “Between baseline and 12 months, there were positive correlations between changes in liver fat and ALT (r = 0.64; p < 0.0001), GGT (r = 0.38; p = 0.013) and AST (r = 0.36; p = 0.018) (Figure 3a–c).”
    Quote in the paperSubstantial claim
  • Findingown data

    Prevalence of baseline MASLD was 86.4% (n = 51/59).

    “Prevalence of baseline MASLD was 86.4%.”
    • Also stated in: § Results · plain
      “The baseline prevalence of MASLD (defined as above the upper limit of normal) was 86.4% (n = 51/59).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Baseline liver fat was elevated at 13.0 [7.8-23.3]% in the type 2 diabetes group.

    “Baseline liver fat was elevated at 13.0 [7.8–23.3]% with fasting plasma glucose 7.9 [7.1–10.1] mmol/L.”
    • Also stated in: § Results · plain
      “Liver fat content was grossly elevated at baseline at 13.0 [7.8–23.3]% (upper level of normal 5.6%).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Liver fat normalised at 12 months to 1.8 [1.2-5.2]% (p < 0.0001).

    “After weight loss of 11.9 ± 1.2 kg (0–37 kg) at 12 months, remission of MASLD occurred in 74% and liver fat normalised for many (1.8 [1.2–5.2]%; p < 0.0001) as did fasting glucose (5.9 [5.5–7.2] mmol/L; p < 0.0001).”
    • Also stated in: § Results · plain
      “It decreased to 1.8 [1.2–5.2]% at 12 months (p < 0.0001) becoming comparable with NDC (1.9 [1.0–4.9]%, p = 0.99).”
    Quote in the paperSubstantial claim
  • Findingown data

    ALT decreased at 12 months by 38 [19-60]% (p < 0.0001).

    “Alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) decreased at 12 months by 38 [19–60]% (p < 0·0001) and 38 [16–53]% (p < 0.0001) respectively.”
    • Also stated in: § Liver enzymes · plain
      “Alanine aminotransferase (ALT) fell after weight loss by 38 [19–60]%: from 30.8 [22.1–38.1] IU/L at baseline to 15.8 [13.7–20.3] IU/L (p < 0.0001) at 12 months (Table 1).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 8
  • The quote only partly states this claim. 1
  • May combine two claims. 18

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    Baseline fasting plasma glucose was 7.9 [7.1-10.1] mmol/L in the type 2 diabetes group.

    “Baseline liver fat was elevated at 13.0 [7.8–23.3]% with fasting plasma glucose 7.9 [7.1–10.1] mmol/L.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    After weight loss of 11.9 ± 1.2 kg at 12 months, remission of MASLD occurred in 74% of those with MASLD at baseline.

    “After weight loss of 11.9 ± 1.2 kg (0–37 kg) at 12 months, remission of MASLD occurred in 74% and liver fat normalised for many (1.8 [1.2–5.2]%; p < 0.0001) as did fasting glucose (5.9 [5.5–7.2] mmol/L; p < 0.0001).”
    • Also stated in: § Results · plain
      “Remission of MASLD (liver fat content below the 5.6% threshold) was achieved at 12 months in 26 of the 35 people with MASLD at baseline (74.3%) or 26 of the total 42 type 2 diabetes people (61.9%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The BARD score of fibrosis was not changed at 12 months but had improved at 24 months.

    “The BARD score of fibrosis was not changed at 12 months (2.7 ± 0.2 vs. 2.8 ± 0.2 at baseline, p = 0.800) but had improved at 24 months (2.4 ± 0.2; p = 0.041) compared both with baseline and 12 months values (p = 0.032).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    ALT decreased by 48 [32-61]% in those losing >10 kg and by 23 [14-54]% in those losing <10 kg at 12 months.

    “When considered in relation to degree of weight loss, ALT decreased by 48 [32–61]% and 23 [14–54]%, in those losing >10 kg and <10 kg respectively at 12 months.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At 24 months, ALT had increased from 12-month values to 21.6 [17.0-26.0] IU/L but remained significantly lower than baseline (p < 0.001).

    “At 24 months, ALT had increased from 12‐month values to 21.6 [17.0–26.0] IU/L but remained significantly lower than baseline (p < 0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    AST fell by 22.8 [12.7-35.9]% at 12 months in the >10 kg weight loss subgroup and by 11.9 [−10.5-39.1]% in those who lost <10 kg.

    “AST fell by 22.8 [12.7–35.9]% at 12 months in the >10 kg weight loss subgroup (p < 0.0001) and by 11.9 [−10.5–39.1]% in those who lost <10 kg (p = 0.050).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At both 12 and 24 months, ALT was not significantly different from NDC (p = 0.088 and p = 0.308 respectively).

    “At both 12 and 24 months, ALT was not significantly different from NDC (18.5 [15.8–26.5] IU/L) (p = 0.088 and p = 0.308 respectively).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Change in weight correlated with BMI (r = 0.91; p < 0.0001).

    “Change in weight correlated with change in hepatic steatosis index at 12 months (r = 0.65; p < 0.0001) as well as with absolute weight (r = 0.58; p < 0.0001), BMI (r = 0.91; p < 0.0001) and liver fat (r = 0.47; p = 0.002) (Figure 4), fatty liver index (r = 0.56, p = 0.001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    GGT became close to NDC at 12 months (p = 0.674) and 24 months (p = 0.566).

    “It became close to that of the NDC group (19.5 [15.8–41.8] IU/L) at 12 months (p = 0.674) and 24 months (p = 0.566).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Prevalence of MASLD declined to 21.4% (n = 9/42) at 12 months, becoming similar to NDC (24.0%; n = 6/25).

    “the prevalence of MASLD declined to 21.4% (n = 9/42) at 12 months, becoming similar to NDC (24.0%; n = 6/25).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    GGT fell by 52.0 [33.1-63.5]% with weight loss >10 kg and by 28.7 [12.3-37.2]% with weight loss <10 kg at 12 months.

    “GGT fell by 52.0 [33.1–63.5] % (p < 0.0001) and 28.7 [12.3–37.2] % (p = 0.003) respectively with weight losses of >10 kg and <10 kg at 12 months.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For GGT, the optimal threshold for detecting normalisation of liver fat after dietary intervention at 12 months was >35 IU/L at baseline, resulting in a PPV of 92.3%.

    “For GGT the optimal threshold for detecting the normalisation of liver fat content after dietary intervention at 12 months was >35 IU/L at baseline resulting in a PPV of 92.3%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The strongest relationships were observed for ALT rather than GGT, which would be expected to change more with fall in alcohol consumption.

    “However, we observed the strongest relationships for ALT rather than GGT which would be expected to change more with fall in alcohol consumption.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The hepatic steatosis index decreased from 43.2 ± 0.8 at baseline to 39.7 ± 0.8 at 12 months (p < 0.0001) and remained steady at 24 months (40.2 ± 0.8).

    “The hepatic steatosis index decreased from 43.2 ± 0.8 at baseline to 39.7 ± 0.8 at 12 months (p < 0.0001) and remained steady at 24 months (40.2 ± 0.8).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the whole type 2 diabetes group, decreases in ALT and GGT after dietary intervention at 12 months had positive predictive value for normalisation of liver fat content of 75.0% and 90.0% respectively.

    “In the whole type 2 diabetes group, decreases in ALT and GGT after dietary intervention at 12 months had positive predictive value (PPV) for normalisation of liver fat content of 75.0% and 90.0% respectively.”
    • Also stated in: § DISCUSSION · plain
      “The positive predictive value for normalisation of liver fat post weight loss was 75% and 90% for ALT and GGT respectively”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A weight loss of 13.5% after either bariatric surgery or dietary induced weight loss achieves a maximum decrease in liver fat.

    “A weight loss of 13.5% after either bariatric surgery or dietary induced weight loss achieves a maximum decrease in liver fat.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Steven S, Hollingsworth KG, Small PK, et al. Calorie restriction and not glucagon‐like peptide‐1 explains the acute improvement in glucose control after gastric bypass in type 2 diabetes. Diabet Med. 2016; 33(12): 1723‐ 1731. 27589584 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    The participants on DiRECT reflected typical white European ethnicity with mean BMI 34.9 kg/m2, but it cannot be assumed that plasma liver enzymes will have the same relationship in people of differing ethnicity.

    “The participants on DiRECT reflected the populations studied (typical white European ethnicity with mean BMI 34.9 kg/m2) but it cannot be assumed that plasma liver enzymes will have the same relationship in people of differing ethnicity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    In DiRECT, known alcohol or other substance abuse was an exclusion, although undeclared prior high consumption cannot be ruled out.

    “In DiRECT, known alcohol or other substance abuse was an exclusion although we cannot rule out undeclared prior high consumption.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Full data on liver fat and LFT were available on 59 participants at baseline and on 42 participants for paired data at baseline, 12 and 24 months.

    “Full data on liver fat and LFT were available on 59 participants at baseline and on 42 participants for paired data at baseline, 12 and 24 months.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Reversal of hepatic fibrosis has been detected using transient elastography after bariatric surgery.

    “Importantly, reversal of hepatic fibrosis has been detected using transient elastography after bariatric surgery.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Nickel F, Tapking C, Benner L, et al. Bariatric surgery as an efficient treatment for non‐alcoholic fatty liver disease in a prospective study with 1‐year follow‐up: BariScan study. Obes Surg. 2018; 28(5): 1342‐ 1350. 29119336 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The inter-scan Bland-Altman repeatability coefficients were 0.5% for the liver.

    “The inter‐scan Bland–Altman repeatability coefficients were 0.5% for the liver.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    In the present study, the BARD score decreased at 2 years, suggesting potential improvement in fibrosis after dietary weight loss.

    “In the present study, the observation of decrease of the BARD score at 2 years is notable, suggesting potential improvement in this serious condition after dietary weight loss.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The clinical utility of tracking the return to normal using liver function tests or derived indices is relevant to monitoring liver health during remission of type 2 diabetes and to wider management of people with presumed or proven MASLD.

    “The clinical utility of tracking the return to normal using liver function tests or derived indices is relevant not only to monitoring liver health during remission of type 2 diabetes but also to the wider management of people with presumed or proven MASLD.”
    Quote in the paperNot a substantial claim
23 of 23

  • The paper relies on this without support.

    There are currently no simple, reliable methods of measuring liver fat in primary care.

    “There are currently no simple, reliable methods of measuring liver fat in primary care.”

  • The paper relies on this without support.

    Liver function tests have wide variability in apparently healthy people under many metabolic and environmental influences but remain fairly constant within any individual.

    “Liver function tests have a wide variability in apparently healthy people under many metabolic and environmental influences but remain fairly constant within any individual.”

  • The paper relies on this without support.

    Liver enzymes rise when there is any injury to liver tissue, and intrahepatic fat is such a causative factor in part via local, low-grade inflammation.

    “They rise when there is any injury to liver tissue, and intrahepatic fat is such a causative factor in part via local, low‐grade inflammation.”

  • The paper relies on this without support.

    The upper level of ALT regarded as normal is based on general populations that include many overweight, possibly prediabetic, and undiagnosed fatty liver individuals.

    “The upper level of ALT which may be regarded as ‘normal’ is open to question as the thresholds are based upon the values found in general populations which include many individuals who are overweight, possibly with prediabetes, and who have undiagnosed fatty liver disease.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • GGT reflects liver adiposity in addition to alcohol intake signals.

    “liver adiposity in addi tion to alcohol intake signals (GGT)”

    From Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide (2026) · cites this paper as [29]

  • Leptin reflects total obesity or percent fat mass.

    “consistent with their roles as biomarkers reflecting total obesity or percent fat mass (leptin)”

    From Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide (2026) · cites this paper as [29]

    The Introduction describes liver enzymes and derived indices as potential markers of liver fat, not leptin as a marker of total obesity or percent fat mass. Searches for “leptin” and “percent fat mass” found no passage addressing that relationship in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • HOMA-IR reflects insulin resistance and ectopic and total fat.

    “insulin resistance and ectopic and total fat (HOMA-IR). 2,29-31”

    From Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide (2026) · cites this paper as [29]

    The Measurements and analytical procedures section reports fasting glucose and insulin measurements, and Table 1 reports weight and liver fat, but neither identifies or evaluates HOMA-IR. Searches for “HOMA-IR” and “homeostasis model assessment” found no passage showing that HOMA-IR reflects insulin resistance or ectopic and total fat. Page numbers were not available in our copy. (LLM, conf=0.73)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting 24-month liver-fat interquartile ranges

    Minor

    The Results give a 24-month liver-fat interquartile range of 5.7-7.9%, whereas Table 1 gives 3.0-9.0% for the same time point and group.

1 of 1

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Authors
Zhyzhneuskaya, S. V., Al‐Mrabeh, A. H., Peters, C., Barnes, A. C., Hollingsworth, K. G., Welsh, P., Sattar, N., Lean, M. E. J., & Taylor, R.
Affiliations
  • County Durham and Darlington NHS Foundation Trust (GB)
  • Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University Newcastle upon Tyne UK
  • Newcastle University (GB)
  • University of Glasgow (GB)
Corresponding author
Taylor, R.
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2024-12-08
Volume
42
Issue
3
Pages
e15462-e15462
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/dme.15462
PMC
PMC11823348
OpenAlex
W4405167513
Semantic Scholar
b49501f28f09379cb6ae6c5e9eee10a8b09a863a
Cited by
6
References
31
Citations by year
2026: 2 · 2025: 4
FWCI
1.81
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetic Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by)
Funders
Diabetes UK
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Keywords
non-alcoholic fatty liver disease, liver function tests, alanine aminotransferase, gamma-glutamyl transferase, weight loss, liver fat, ectopic fat, fatty liver index, hepatic steatosis index, diabetes remission, Dixon MRI, positive predictive value
MeSH terms
Adult, Alanine Transaminase, Diabetes Mellitus, Type 2, Fatty Liver, Female, gamma-Glutamyltransferase, Humans, Liver, Liver Function Tests, Magnetic Resonance Imaging, Male, Middle Aged, Obesity, Remission Induction, Weight Loss, Non-alcoholic Fatty Liver Disease

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