title: Total body weight loss of ≥ 10 % is associated with improved hepatic fibrosis in patients with nonalcoholic steatohepatitis.
abstract: BACKGROUND
  Given the rising epidemics of obesity and metabolic syndrome, nonalcoholic steatohepatitis (NASH) is now the most common cause of liver disease in the developed world. Effective treatment for NASH, either to reverse or prevent the progression of hepatic fibrosis, is currently lacking.
  
  
  OBJECTIVE
  To define the predictors associated with improved hepatic fibrosis in NASH patients undergoing serial liver biopsies at prolonged biopsy interval.
  
  
  METHODS
  This is a cohort study of 45 NASH patients undergoing serial liver biopsies for clinical monitoring in a tertiary care setting. Biopsies were scored using the NASH Clinical Research Network guidelines. Fibrosis regression was defined as improvement in fibrosis score ≥1 stage. Univariate analysis utilized Fisher's exact or Student's t test. Multivariate regression models determined independent predictors for regression of fibrosis.
  
  
  RESULTS
  Forty-five NASH patients with biopsies collected at a mean interval of 4.6 years (±1.4) were included. The mean initial fibrosis stage was 1.96, two patients had cirrhosis and 12 patients (26.7 %) underwent bariatric surgery. There was a significantly higher rate of fibrosis regression among patients who lost ≥10 % total body weight (TBW) (63.2 vs. 9.1 %; p = 0.001) and who underwent bariatric surgery (47.4 vs. 4.5 %; p = 0.003). Factors such as age, gender, glucose intolerance, elevated ferritin, and A1AT heterozygosity did not influence fibrosis regression. On multivariate analysis, only weight loss of ≥10 % TBW predicted fibrosis regression [OR 8.14 (CI 1.08-61.17)].
  
  
  CONCLUSIONS
  Results indicate that regression of fibrosis in NASH is possible, even in advanced stages. Weight loss of ≥10 % TBW predicts fibrosis regression.
authors.affiliation: Section of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Glass
authors.forename: Rolland C
authors.initials: RC
authors.lastname: Dickson
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Anderson
authors.forename: Arief A
authors.initials: AA
authors.lastname: Suriawinata
authors.forename: Juan
authors.initials: J
authors.lastname: Putra
authors.forename: Brian S
authors.initials: BS
authors.lastname: Berk
authors.forename: Arifa
authors.initials: A
authors.lastname: Toor
mesh_terms: D000328:Adult; D004038:Diet, Reducing; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000178:diet therapy* / Q000473:pathology; D012189:Retrospective Studies; D015431:Weight Loss