Wednesday, June 3, 2009
DDW: Nonalcoholic steatohepatitis
Although everyone would like a quick fix to treat nonalcoholic steatohepatitis (NASH) and its attendant problems with blood pressure and diabetes, the best bet seems to be the one that can be hardest to sell to patients: weight loss.
The question then becomes, which is the most effective way to make that happen? During today's session on "Approaches to Weight Loss in NASH: When and How Aggressive," presenter Kittichai Promrat, MD, made the case for lifestyle intervention. He said a recent study he was involved with showed a 9.3% weight reduction in patients who received a portion-control diet, a meal plan, a pedometer to measure steps, and other interventions versus 0.2% of those who did not.
The major challenge after that, he said, is finding a self-regulating program that will help patients maintain that weight loss.
Is one diet better than another? According to Dr. Promrat, the answer is no. He cited a recent study that found that while a low-carb diet reduced more fat initially, once patients reached 7% weight loss, the amount of fat reduction was the same. And because compliance is so difficult, he recommended that doctors be flexible.
"A diet that fits the patient's personal preference and can be maintained is best," he said.
Before recommending surgery...
At that same session, Raphael Merriman, MD, urged caution when looking to bariatric surgery to resolve NASH. He said that's a very real concern given that in 2008 there were more than 200,000 bariatric surgeries, what he called "a staggering number."
Although some data show promising results with certain types of bariatric procedures, he said more is needed to make the recommendation. He noted that the surgery's main goal is weight loss--not fixing NASH. In fact, not all patients undergoing the procedure have fatty liver disease.
--By Paula Katz, special to ACP Internist
Labels: digestive disease week, NASH, weight loss
posted by Janet Colwell at
8:39 AM
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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