Lifestyle Modification in Advanced Fibrosis From NASH

The current role of lifestyle modification in regard to the management of patients with advanced fibrosis due to nonalcoholic steatohepatitis.

Transcript

Viviana Figueroa Diaz, MD: The standard of care for the treatment of advanced fibrosis due to NASH [nonalcoholic steatohepatitis] includes diet modification, exercise, and achieving weight loss. Not only that, but because there is usually what we call metabolic syndrome, we also have to make sure that the patient’s sugar levels or diabetes is under control. We also have to make sure the patient is active and that their cholesterol and blood pressure are under control. All that is part of the standard of care, to allow the liver to get rid of the fat and then eventually dissolve the scar tissue, or fibrosis, and start regressing.

Norman Sussman, MD: The most important thing is to recognize how far advanced the fibrosis is and try to get the patient to understand the importance of changing the rate at which the liver disease is occurring. So if someone has all the features of metabolic syndrome, and you can get them to change their lifestyle, improve their weight, keep their blood sugar under control, and manage their blood lipids, you may see complete stabilization followed by resolution of the disease.

Resolution of NASH occurs when people lose about 8% of their body weight. Resolution of fibrosis occurs when they lose about 10% of their body weight. Lifestyle changes along with an improvement in health may have a huge impact on someone’s advanced fibrosis.

What lifestyle modifications should the patient make? The most important factor is usually dietary change. That includes reducing the amount of sugar in their diet and then adding in a certain amount of exercise. Everyone’s definition of a lot of exercise is different, but we like to recommend 150 minutes per week. With those changes, I expect to see about 80% of people lose weight initially. Studies have shown that about 20% of people won’t maintain their weight, and I think a lot of that comes down to the provider encouraging the patient and giving them good advice on how to manage their weight and live a healthy lifestyle.

Viviana Figueroa Diaz, MD: Regarding the success rate of lifestyle modifications, if the patient commits, the modifications start regressing the disease. The problem is that because there’s so much on the patient in terms that it’s really changing your life and is not temporary; it’s lifelong. It’s a big commitment to have from the patient. So we do struggle to have success, in terms of who can achieve the regression, because not everybody is able to commit.