Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The sportdiet study.

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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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Berzigotti, Annalisa and Bosch, Jaime

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0270-9139

Publisher:

Wiley Interscience

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

09 Feb 2017 10:40

Last Modified:

21 Dec 2017 02:30

Publisher DOI:

10.1002/hep.28992

PubMed ID:

27997989

Uncontrolled Keywords:

HVPG; adipokines; diet; exercise; liver disease; quality of life

BORIS DOI:

10.7892/boris.93580

URI:

https://boris.unibe.ch/id/eprint/93580

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