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

• Published in: PloS one Vol. 9; no. 11; p. e111808
• Main Authors: Dudekula, Anwar, Rachakonda, Vikrant, Shaik, Beebijan, Behari, Jaideep
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.11.2014; Public Library of Science (PLoS)
• Subjects: Adult; Ambulatory Care; Body composition; Body mass; Body Mass Index; Body weight; Body weight loss; Cardiovascular disease; Celiac disease; Codes; Diabetes; Emergency medical services; Fatty liver; Gastroenterology; Gastrointestinal surgery; Heart surgery; Hepatitis; Hepatology; HIV; Human immunodeficiency virus; Humans; Liver; Liver cancer; Liver cirrhosis; Liver diseases; Logistic Models; Male; Medicine; Medicine and Health Sciences; Middle Aged; Non-alcoholic Fatty Liver Disease - epidemiology; Nutrition research; Obesity; Obesity - complications; Obesity - epidemiology; Overweight; Patients; Population; Retrospective Studies; Task forces; Transplants & implants; Underweight; Weight control; Weight Loss; Weight loss measurement; Weight reduction; United States > US; Pittsburgh Pennsylvania; Pennsylvania
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0111808

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. 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. 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. 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.