One-year intense nutritional counseling results in histological improvement in patients with non-alcoholic steatohepatitis: a pilot study.
OBJECTIVE
In individuals with biopsy-proven non-alcoholic steatohepatitis (NASH), short-term weight loss has been shown to improve biochemical abnormalities; however, its effect on liver histology is largely unknown. The aim of the article is to determine if dietary intervention is effective in improving histological features of steatohepatitis in patients with biopsy-proven NASH.


METHODS
Twenty-three patients (11M/12F) with BMI >25 kg/m(2) and biopsy-proven NASH received standardized nutritional counseling aimed at reducing insulin resistance (IR) and weight. Blood tests were checked at baseline and every 1-4 months, and liver biopsy was repeated at month 12. IR was assessed by the homeostasis model assessment (HOMA). Liver biopsies were scored according to modified Brunt criteria for NASH. "Histologic response" was defined as a reduction in total NASH score of >/=2 points with at least one point being in the non-steatosis component.


RESULTS
Sixteen patients (8M/8F) completed 12 months of dietary intervention, and 15 underwent repeat liver biopsies. At month 12, mean weight decreased from 98.3 to 95.4 kg. Mean waist circumference, visceral fat, fasting glucose, IR, triglycerides, AST, ALT, and histologic score were all reduced but the difference was not significant. Nine patients had a histologic response, six had stable scores, and none had a worsened score. Compared to patients with unchanged histologic scores, patients with improved scores had significantly greater reduction in weight, waist circumference, AST, ALT, steatosis grade, and total NASH score.


CONCLUSIONS
Among patients who successfully completed 1 yr of intense dietary intervention, nine of 15 patients with NASH displayed histologic improvement. This pilot study suggests that dietary intervention can be effective in improving histology in patients with biopsy-proven NASH.
Huang
Mary Ann
MA
Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Greenson
Joel K
JK
Chao
Cewin
C
Anderson
Lilian
L
Peterman
Debra
D
Jacobson
Jon
J
Emick
Dawn
D
Lok
Anna S
AS
Conjeevaram
Hari S
HS
D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D001786:Blood Glucose / Q000032:analysis; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D003376:Counseling; D005234:Fatty Liver / Q000097:blood / Q000178:diet therapy* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006505:Hepatitis / Q000097:blood / Q000178:diet therapy / Q000473:pathology; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D052756:Nutritional Sciences / Q000193:education*; D010865:Pilot Projects; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss / Q000502:physiology
D001786:Blood Glucose; D014280:Triglycerides; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase