Rapid weight loss may promote advanced fatty liver disease – new research

About 2% of adults worldwide suffer from a condition called non-alcoholic steatohepatitis (Nash), an advanced form of non-alcoholic fatty liver disease. This occurs when fat builds up in the liver, causing inflammation and scarring.

Without treatment it can eventually lead to cirrhosis of the liver – and can also increase the risk of other serious health conditions, such as heart disease.

There is currently no medication to treat Nash. Since it is the excess fat in the liver that causes the inflammation and scarring that are characteristic of the condition, the mainstay of current treatment for patients is weight loss.

However, the kind of weight loss that most people can achieve on their own is modest and not enough to significantly reduce liver fat and change inflammation and scarring.

But our recent research suggests that rapid weight loss achieved through the “soups and shakes” diet — commonly used to treat obesity and type 2 diabetes — may reduce the severity of Nash.

To conduct our study, we recruited 16 participants with obesity, Nash and moderate to advanced liver scarring. Five participants were women and 11 men. Most of the participants were white.

All participants took part in a “soups and shakes” weight loss program, replacing their regular meals with specially formulated soups, shakes, and bars for 12 weeks. They ate four of their choice of products each day, which provided them with about 880 calories and all the essential vitamins and minerals.

After the initial 12 week period, they gradually begin to reintroduce regular foods into their diet over the next 12 weeks. They were also given regular support from a dietitian to keep them on track and motivated throughout the 24-week study.

At the start of the study, participants were weighed, had their blood pressure taken, blood tests were done and two scans that measured the health of their liver. This scan estimated how advanced their liver inflammation and scarring was and the amount of fat in their liver.

This test is also repeated at 12 and 24 weeks – with an additional blood test done at four weeks.

Fourteen participants completed the 24-week study. Participants lost an average of 15% of their body weight, indicating that they were mostly on a weight loss program.

Our study also shows that rapid weight loss is safe for participants. In the past, this type of diet was not recommended for Nash’s patients due to safety concerns. The most common side effect patients experience is constipation – but this is temporary and usually only mild.

The scans also showed that most of the participants had significant increases in fatty liver and markers of inflammation and scarring of the liver.

The improvement is bigger than the treatment

These are some of the largest increases in liver disease severity reported in studies to date, approaching the levels of improvement seen with weight loss after bariatric surgery. No experimental drug has shown an increase of that magnitude.

While some weight gain is likely to occur, if participants are able to maintain at least most of their weight loss after the study ends, it may be able to reverse the trajectory of their liver disease.

What’s more, systolic blood pressure and hemoglobin A1C (a marker of blood sugar control) were also significantly improved in participants with hypertension and type 2 diabetes at the start of the study. This may indicate that the program could be used to reduce the risk of heart disease, which is the most common cause of death in people with Nash.

Because our results are from a small study, further research is needed to test this program in larger trials with a more diverse participant and control group. It will also be interesting to see if this program can benefit patients suffering from more advanced forms of liver disease – such as cirrhosis of the liver.

But it is promising to see from our study that the diet appears to be safe for people with Nash and effective in improving their liver health.