The Effect of a 12-Month Intensive Lifestyle Intervention on Hepatic Steatosis in Adults with type 2 Diabetes
- Mariana Lazo, MD ScM (mlazo{at}jhsph.edu)1,
- Steven F. Solga, MD2,
- Alena Horska, PhD3,
- Susanne Bonekamp, DVM2,
- Anna Mae Diehl, MD4,
- Frederick L. Brancati, MD MHS1,2,
- Lynne E Wagenknecht, DrPH5,
- F. Xavier Pi-Sunyer, MD MPH6,
- Steven E. Kahn, MB, ChB7,
- Jeanne M. Clark, MD MPH1,2 and
- for the Fatty Liver Subgroup of the Look AHEAD Research Group
- 1 Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research
- 2 Johns Hopkins Medicine
- 3 Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD
- 4Duke University Medical Center, Durham, NC.
- 5 Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC.
- 6 Division of Endocrinology, Diabetes and Nutrition, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY
- 7 Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
Abstract
Objective: Weight loss through lifestyle changes is recommended for nonalcoholic fatty liver disease (NAFLD), however its efficacy in patients with type 2 diabetes is unproven.
Research Design and Methods: Look AHEAD is a 16-center clinical trial with 5145 overweight or obese adults with type 2 diabetes, who were randomly assigned to an intensive lifestyle intervention (ILI) to induce a minimum weight loss of 7%, or a control group who received diabetes support and education (DSE). In the Fatty Liver Ancillary Study, 96 participants completed proton-magnetic resonance spectroscopy (1H-MRS) to quantify hepatic steatosis and tests to exclude other causes of liver disease at baseline and 12-months. We defined steatosis > 5.5% as NAFLD.
Results: Participants were 49% women and 68% white. The mean age was 61 years, mean BMI 35 kg/m2, mean steatosis 8.0% and mean AST and ALT 20.5 and 24.2 U/L respectively. After 12 months, participants assigned to ILI (n=46), as compared to DSE (n=50), lost more weight (−8.5% vs. −0.05%; p<0.01), had a greater decline in steatosis (−50.8% vs. −22.8%; p=0.04) and in A1c (−0.7% vs. −0.2%; p=0.04).There were no significant 12-month changes in AST or ALT levels. Twenty-six percent (6 of 23) of DSE participants and 3% (1 of 31) of ILI participants without NAFLD at baseline developed NAFLD at 12 months (p<0.05).
Conclusions: A 12-month intensive lifestyle intervention in patients with type 2 diabetes reduces steatosis and incident NAFLD.
Footnotes
- Copyright © American Diabetes Association
