By Lisa Rapaport

People who have fatty liver disease related to being overweight may get the disease under better control when they get lots of support to lose weight, a research review suggests.

Most people have a little bit of fat in their liver, but fatty liver disease can be diagnosed when more than 5% of the liver is made up of fat. If the condition isn’t linked to liver damage from heavy drinking, it’s known as non-alcoholic fatty liver disease (NAFLD) and is most often associated with obesity and certain eating habits.

For the current analysis, researchers examined data on 2,588 patients who were participating in 22 clinical trials of various interventions to help them lose weight. Fifteen studies tested behavioral weight loss programs; six tested medications; one tested weight loss surgery.

The trials also looked at whether those interventions would improve biomarkers for NAFLD that can help predict the likelihood of serious complications.

Compared with little or no weight loss support, the interventions that offered the most support were associated with greater weight loss and bigger reductions in biomarkers for NAFLD like elevated liver enzymes in the blood, elevated blood sugar, and reduced sensitivity to the hormone insulin, or insulin resistance.

“It shows clearly that weight loss improves the health of the liver,” said Dimitrios Koutoukidis, a researcher at the University of Oxford in the U.K. and lead author of the study.

“We found some evidence that weight loss improved NAFLD through improvements in the control of blood glucose levels and reductions in insulin resistance, but we need more research to understand the exact mechanisms,” Koutoukidis said by email.

Different approaches to weight loss didn’t appear to impact whether fibrosis, or scarring, in the liver got better or worse.

Worldwide, about one in four adults have NAFLD, as do at least half of people with obesity, researchers note in JAMA Internal Medicine.

There’s no drug treatment for NAFLD. Doctors typically advise patients to lose weight by cutting calories and getting more exercise, or sometimes by taking weight-loss medications or considering weight-loss surgery. The new findings, according to the researchers, “appear to support the need to change the clinical guidelines and to recommend formal weight loss programs for people with NAFLD.”

One limitation of the analysis is that the smaller studies tested a wide range of weight-loss interventions over varying lengths of time and used different tests to assess patients’ liver disease.

Still, weight loss through a combination of dietary improvements and increased exercise can improve fatty liver, said Dr. Danielle Brandman, director of the Fatty Liver Clinic at the University of California San Francisco and coauthor of an editorial accompanying the study.

Ideally, patients should try to lose 7% of their weight and maintain this weight loss in order to have long-term improvements in NAFLD, Brandman said by email.

“Patients have the potential to improve or cure their disease,” Brandman said.

“However, they should know that this is an ultra-marathon rather than a sprint,” Brandman added. “Weight loss – and the behavior change needed to achieve it – can be really difficult for many patients for a variety of reasons.”

SOURCE: JAMA Internal Medicine, online July 1, 2019.