Study data published in Clinical and Translational Gastroenterology support the feasibility of a very low-calorie diet (VLCD) to enable sustained weight loss in patients with nonalcoholic fatty liver disease (NAFLD). Among patients who completed at least 8 weeks of VLCD, researchers observed significant improvements in liver stiffness, cardiovascular disease (CVD) risk, metabolic health, and body composition. These changes were sustained over 9 months of follow-up.
Lifestyle modification involving weight loss is the primary nonpharmaceutical therapy for NAFLD. Although prior research has shown that weight loss can improve liver parameters in patients with NAFLD, maintenance of weight loss decreases over time. Investigators sought to assess the acceptability of a 12-week VLCD for achieving sustained weight loss. They recruited patients with clinically significant NAFLD and body mass index (BMI; >27 kg/m2) from hospitals in the United Kingdom between January and July 2019. The researchers instructed participants to maintain a 12-week VLCD (~800 kcal/d) using meal replacement products.
The primary outcomes were feasibility and acceptability of the VLCD, defined as the proportion of patients achieving and sustaining at least a 10% weight loss over 6 months or more of follow-up. Investigators measured anthropometrics, blood tests, liver stiffness, and CVD risk at baseline, after completion of VLCD, and at 9-months follow-up.
The study cohort comprised 30 patients, among whom 27 (90%) completed the VLCD and 20 (67%) were retained at 9 months. Mean age was 56 plus or minus 12 years; mean BMI was 42 plus or minus 8 kg/m2. At baseline, 16 (53%) patients had type 2 diabetes and 13 (43%) had full metabolic syndrome. All patients who completed the VLCD achieved and maintained some degree of weight loss.
Overall, 80%, 75%, and 50% of patients achieved at least 5%, 7%, and 10% weight loss, respectively, at 9 months. Mean weight loss was 8.9% (±8.1%) of body weight. No treatment-related serious adverse events were reported. The most commonly reported adverse effects during the VLCD phase were constipation (37%), dizziness (19%), headaches (11%), and increased sensitivity to cold (7%).
In the intent-to-treat analysis, patients who completed 12 weeks of VLCD had a significantly greater mean weight loss at 9 months than patients who completed just 8 weeks of VLCD (13.4%±7.8% vs 4.4%±5.4%, P =.002). Among patients who completed 8 weeks of VLCD, investigators observed significant improvements in liver enzymes and liver stiffness at both the post-VLCD and 9-month timepoints.
Metabolic health also improved, with fasting glucose, glycated hemoglobin, and insulin levels each declining after VLCD completion. Blood pressure and cardiovascular risk score also decreased between baseline and the post-VLCD timepoint. These changes were maintained at 9 months. Patients reported significantly better quality of life at 9 months compared with baseline. In addition, 30% of patients decreased the number of medications they were taking during the study.
These data support the feasibility of a short-term VLCD for implementing and sustaining weight loss in patients with NAFLD. Sustained weight loss was accompanied by improvements in liver health, CVD risk, and metabolic parameters.
The primary study limitation is the small cohort size, which limits the generalizability of data. In addition, there was no control group with which to compare weight loss results. Further study in a larger cohort with a longer follow-up period is necessary to better explore the long-term impact of VLCD.
“A VLCD intervention offers a holistic treatment option that could be incorporated as part of clinical care for some patients with NAFLD,” investigators wrote.
Scragg J, Avery L, Cassidy S, et al. Feasibility of a very low calorie diet to achieve a sustainable 10% weight loss in patients with nonalcoholic fatty liver disease. Clin Transl Gastroenterol. 2020;11(9):e00231. doi: 10.14309/ctg.0000000000000231