Berzigotti, Annalisa; Albillos, Agustín; Villanueva, Candid; Genescá, Joan; Ardevol, Alba; Augustín, Salvador; Calleja, Jose Luis; Bañares, Rafael; García-Pagán, Juan Carlos; Mesonero, Francisco; Bosch, Jaime (2017). Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The sportdiet study. Hepatology, 65(4), pp. 1293-1305. Wiley Interscience 10.1002/hep.28992
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EFFECTS OF AN INTENSIVE LIFESTYLE INTERVENTION.pdf - Accepted Version Available under License Publisher holds Copyright. Download (1MB) | Preview |
Obesity increases the risk of clinical decompensation in cirrhosis, possibly by increasing portal pressure. Whether weight reduction can be safely achieved through lifestyle changes (diet and exercise) in overweight/obese patients with cirrhosis, and if weight loss reducesportal pressure in this setting is unknown. This prospective, multicentric, uncontrolled pilot study enrolled patients with compensated cirrhosis, portal hypertension (hepatic venous pressure gradient, HVPG≥ 6mmHg) and body mass index (BMI)≥26 Kg/m2 in an intensive 16-week lifestyle intervention program (personalized hypocaloric normoproteic diet and 60 min/wk of supervised physical activity). We measured HVPG, body weight and composition, adipokines, health-related quality-of-life and safety data prior and after the intervention. Changes in HVPG and body weight were pre-defined as clinically relevant if ≥10% and ≥5%, respectively. Safety and body weight were re-assessed after 6 months. 60 patients were included and 50 completed the study (56±8 y/o; 62% male; NASH etiology 24%; BMI 33.3±3.2Kg/m2; Child A 92%; HVPG ≥10 mmHg 72%). Lifestyle intervention significantly decreased body weight (average -5.0±4.0 Kg; p<0.0001), by ≥ 5% in 52% and ≥10% in 16%. HVPG also significantly decreased (from 13.9±5.6 mmHg to 12.3±5.2 mmHg, p<0.0001), by ≥10% in 42% and ≥20% in 24%. A ≥10% body weight loss was associated with a greater decrease in HVPG (-23.7±19.9% vs. -8.2±16.6%,p=0.024). No episodes of clinical decompensation occurred. Weight loss achieved at 16-wks was maintained at 6-month; Child and MELD scores did not change.
CONCLUSIONS
16-weeks of diet and moderate exercise were safe and reduced body weight and portal pressure in overweight/obese patients with cirrhosis and portal hypertension. This article is protected by copyright. All rights reserved.
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