Obesity-related nonalcoholic fatty liver disease (NAFLD) is becoming an epidemic due to its rising incidence is rising. This may further progress to nonalcoholic steatohepatitis (NASH), which can further advance into liver cirrhosis. Usually recommended therapy for managing obesity-related NASH is weight loss. Although adapting better lifestyle may improve NASH; several trials still have been performed only on overweight patients, patients with obesity are at highest risk of developing NAFLD. 

The present real-life cohort study assessed the effect of lifestyle modification on morbidly obese patients with NAFLD. The authors enrolled 152 patients, who underwent lifestyle intervention, with a follow-up of 52 weeks. Noninvasive parameters of obesity, metabolic syndrome, liver steatosis, liver damage, and liver fibrosis were examined. 

The outcome showed that the treatment response in terms of weight loss was accomplished in 85.1% of patients with amelioration of dysglycemia and dyslipidemia. The proportion of patients with fatty liver reduced from 98.1 to 54.3%. Weight loss >10% was correlated with better treatment response. Prevalence of abnormal serum transaminases reduced from 81.0 to 50.5%. The proportion of fibrotic patients, as assessed by the NAFLD fibrosis score, fell from 11.8 to 0%. Low serum levels of adiponectin was found to be associated with degree of liver damage, i.e., serum liver transaminases, however, serum levels of adiponectin were observed to be increased with lifestyle modification. 

Thus, the study showed that lifestyle modification focussing on weight gain was an efficient approach to target obesity and the metabolic syndrome. Moreover, based on the study, liver steatosis, damage and fibrosis were improved morbidly obese patients, which was mediated in part by alteration in the adipokine profile. It was also seen that the patients with weight loss of >10% had maximum benefit in improving liver disease. 

Thus, it can be concluded that lifestyle modification has a potential beneficial effect in treating NAFLD in group of patients with morbid obesity. As per the current guidelines recommended for the management of NASH, weight loss of 5-7% is usually advised, weight reduction of >10% may be more advantageous in morbid obesity. Furthermore, serum levels of adipokines are associated with liver damage, suggestive of their pathogenic role in NASH. 

Source: Hohenester S, Christiansen S, Nagel J, Wimmer R, Artmann R, Denk G, Bischoff M, Bischoff G, Rust C. Lifestyle intervention for morbid obesity: effects on liver steatosis, inflammation, and fibrosis. Am J Physiol Gastrointest Liver Physiol. 2018 Sep 1;315(3):G329-G338.