title: Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study.
abstract: Obesity increases the risk of clinical decompensation in cirrhosis, possibly by increasing portal pressure. Whether weight reduction can be safely achieved through lifestyle (LS) changes (diet and exercise) in overweight/obese patients with cirrhosis, and if weight loss reduces portal pressure in this setting, is unknown. This prospective, multicentric, uncontrolled pilot study enrolled patients with compensated cirrhosis, portal hypertension (hepatic venous pressure gradient [HVPG] ≥6 mm Hg), and body mass index (BMI) ≥26 kg/m2in an intensive 16-week LS intervention program (personalized hypocaloric normoproteic diet and 60 min/wk of supervised physical activity). We measured HVPG, body weight (BW) and composition, adipokines, health-related quality of life, and safety data before and after the intervention. Changes in HVPG and BW were predefined as clinically relevant if ≥10% and ≥5%, respectively. Safety and BW were reassessed after 6 months. 60 patients were included and 50 completed the study (56 ± 8 years old; 62% male; nonalcoholic steatohepatitis etiology 24%; BMI 33.3 ± 3.2 kg/m2; Child A 92%; HVPG ≥10 mm Hg, 72%). LS intervention significantly decreased BW (average, -5.0 ± 4.0 kg; P < 0.0001), by ≥5% in 52% and ≥10% in 16%. HVPG also significantly decreased (from 13.9 ± 5.6 to 12.3 ± 5.2 mm Hg; P < 0.0001), by ≥10% in 42% and ≥20% in 24%. A ≥10% BW loss was associated with a greater decrease in HVPG (-23.7 ± 19.9% vs. -8.2 ± 16.6%; P = 0.024). No episodes of clinical decompensation occurred. Weight loss achieved at 16 weeks was maintained at 6 months; Child and Model for End-Stage Liver Disease scores did not change.
  
  
  
  Sixteen weeks of diet and moderate exercise were safe and reduced BW and portal pressure in overweight/obese patients with cirrhosis and portal hypertension. (Hepatology 2017;65:1293-1305).
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.|Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albillos
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hospital Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Candid
authors.initials: C
authors.lastname: Villanueva
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Genescá
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hospital Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Ardevol
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Augustín
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Calleja
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hospital General Universitario Gregorio Marañon, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Pagán
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mesonero
authors.affiliation: CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.|Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.|Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
mesh_terms: D001823:Body Composition; D015992:Body Mass Index; D003131:Combined Modality Therapy; D015897:Comorbidity; D000072001:Diet, Healthy; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008019:Life Style; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D015431:Weight Loss