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Nafld and the ymca diabetes prevention program: Repurposing an effective lifestyle intervention program for treatment of nonalcoholic fatty liver disease
Hepatology ; 72(1 SUPPL):1026A, 2020.
Article in English | EMBASE | ID: covidwho-986120
ABSTRACT

Background:

Modest weight loss (5-7%) remains the goldstandard of treatment for nonalcoholic fatty liver disease (NAFLD), though patients rarely achieve this independently The YMCA's Diabetes Prevention Program (DPP) is a nationwide structured lifestyle intervention program that has demonstrated weight loss within this range The goal of this study is to determine if the DPP can be repurposed to induce weight loss, decrease liver enzymes, and improve hepatic steatosis in NAFLD

Methods:

Eligible patients had NAFLD (defined by Fibroscan controlled attenuation parameter (CAP) score >238dB/m) and elevated liver enzymes (ALT>25U/L in females, >33U/L in males) without competing etiologies for liver disease Patients with cirrhosis were excluded A retrospective cohort that received standard of care recommendations was analyzed for change in ALT Two sequential prospective cohorts of 20 patients were enrolled in the experimental YMCA DPP Classroom sessions occurred weekly for 16 weeks, bi-weekly for 4 weeks, and then monthly for 48 weeks total Primary endpoints included change in BMI, ALT, and Fibroscan score. Completers were defined as those attending at least 9 of the first 16 weekly sessions. Changes in variables were analyzed using paired t-test End of study data was not completed for cohort 2 due to COVID19 and therefore aggregate data is presented for week 16 and end of study data (week 48) is presented for only cohort 1

Results:

A total of 20 patients from both cohorts were completers 16% were female (n=12) 16 patients had interim study data and were included in the week 16 analysis All but one patient lost weight Baseline mean BMI was 34 3 and decreased to 33 6 by week 16 (p=0 02) Baseline mean ALT was 91 8U/L and decreased to 55 1U/L by week 16 (p=0 005) Mean Fibroscan fibrosis score improved from 6.7kPa to 5.5kPa and CAP score improved from 321dB/m to 291dB/m by week 16 (p=0 008 and p=0 12, respectively) 9 patients from cohort 1 were included in the week 48 analysis Mean BMI was 35 4 at baseline and decreased to 33 6 by week 48 (p=0 002) Mean ALT was 85 0U/L at baseline decreased to 41 6U/L (p=0 01) Mean Fibroscan score improved from 6 9kPa to 5 9kPa (p=0 07) Other metabolic parameters also trended towards significant improvement at week 16 and 48 (Table 1). The retrospective cohort (N=31) had a mean baseline ALT of 69U/L with no significant change at 6-month follow-up (mean ALT 60U/L, p=0 24)

Conclusion:

Standard of care lifestyle recommendations are ineffective in inducing weight loss and improvement in ALT in NAFLD The YMCA DPP repurposed to treat NAFLD resulted in statistically significant improvements in BMI and ALT in patients with NAFLD Fibroscan scores and other metabolic parameters also improved, though the sample size is likely too small to see a statistically significant improvement The existing infrastructure established by the YMCA throughout the U S could emerge as a leading treatment option for NAFLD patients.

Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Hepatology Year: 2020 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Hepatology Year: 2020 Document Type: Article