Weight loss in nonalcoholic Fatty liver disease patients in an ambulatory care setting is largely unsuccessful but correlates with frequency of clinic visits

Abstract

Background and aims: Nonalcoholic fatty liver disease (NALFD) is a leading cause of liver disease. Weight loss improves clinical features of NAFLD; however, maintenance of weight loss outside of investigational protocols is poor. The goals of this study were to characterize patterns and clinical predictors of long-term weight loss in ambulatory patients with NAFLD.

Methods: We retrospectively reviewed 924 non-cirrhotic patients with NAFLD presenting to a liver clinic from May 1st 2007 to April 30th 2013. Overweight and obese patients were counseled on lifestyle modifications for weight loss as per USPSTF guidelines. The primary outcome was percent weight change between the first and last recorded visits: % weight change = (weightinitial - weightfinal)/(weightinitial). Baseline BMI and percent BMI change were secondary measures. Predictors of weight loss were determined using logistic regression.

Results: The mean baseline BMI was 33.3±6.6 kg/m2, and the mean follow-up duration was 17.3±17.6 months. Most patients with NAFLD were in either overweight (26.1%) or class I obesity (30.5%) categories at baseline, while the prevalence of underweight and class III obesity was lower (0.2% and 15.4%, respectively). Overall, there was no change in mean weight or BMI during the follow-up period, and only 183 patients (19.8%) lost at least 5% body weight during the follow up period. Independent predictors of weight loss included number of clinic visits and baseline BMI, and patients with higher baseline BMI required more clinic visits to lose weight.

Conclusions: Weight loss is largely unsuccessful in NAFLD patients in the ambulatory care setting. Frequent clinical encounters are associated with weight reduction, especially among individuals with high baseline BMI. Future studies are required to define effective weight loss strategies in NAFLD patients.

Figure 1. Initial body mass index (BMI) distribution of 924 non-cirrhotic NAFLD patients.

Baseline BMI was stratified using the following definitions: underweight (<18.5 kg/m²), normal weight (18.5–24.99 kg/m²), overweight (25.0–29.99 kg/m²), class I obesity (30.0–34.99 kg/m²), class II obesity (35.0–39.99 kg/m²), and class III obesity (≥40 kg/m²).

Figure 2. Percent change in body weight at the end of the study period relative to the initial weight.

Patients with final body weight within 5% of their initial weight were included in the “No change” group. N = 924 for the entire cohort.

Figure 3. Predicted probability of weight loss (>5% of initial weight) based on number of clinic visits and BMI.

Patients were stratified based on their initial BMI (used as a continuous variable) and number of clinic visits. N = 924 total patients; 2 visits: 354; 3 visits: 202; 4 visits: 130; and 5 or more visits: 238. P<0.001 for 2 visits versus 3, P<0.05 for 2 visits versus 4, and P =  NS for 2 versus 5 or more visits. P =  NS for 3 versus 4, or 5 or more visits.