Prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing among patients with type 1 diabetes (T1D). Little is known about the impact of weight reduction on NAFLD in this population. We utilized the Hepatic Steatosis Index (HSI), a noninvasive surrogate predictor of NAFLD, to evaluate the effect of intensive lifestyle intervention (ILI) on hepatic steatosis in patients with T1D and obesity after one year.
We evaluated 88 adult patients with T1D and obesity who participated in a 12-week ILI program in real-world clinical practice within the past 13 years. We excluded 11 patients per the International Associations for Diagnosis of NAFLD guidelines. A total of 77 patients were included in the analysis (mean age 43±12 years, 65% female, diabetes duration 22±12 years, HSI 46.2±6.1, A1C 8.2±1%, body weight 102.5±17 kg, BMI 35.7±5 kg/m2). We matched them in 1:1 ratio with a cohort of similar T1D patients who received standard diabetes care at the same practice during the same period (mean age 43±12 years, 65% female, diabetes duration 22±9 years, HSI 45±5.7, A1C 8.2±0.9%, body weight 100±17 kg, BMI 35.3±5 kg/m2). HSI was calculated as 8*ALT/AST+BMI (+2 if female). There were no differences in HSI between the 2 cohorts at baseline.
At 1 year, the ILI group lost an average of 5.6±2.7 kg (5.8%, p<0.05) and the control group maintained their baseline body weight (p<0.001 between groups). HSI decreased significantly from baseline in the ILI group (-2.7±1.05, p=0.01) but did not change in the control group (0.6±0.9, p=0.53, p<0.001 between groups). A greater proportion of patients in the ILI group achieved HSI <36 (NAFLD cut-off) (11.7% compared to 1.3% in the control group, p<0.01).
We conclude that an ILI program in real-world clinical practice may improve HSI in patients with T1D and obesity compared to standard care after 1 year. A greater proportion of patients enrolled in ILI achieved HSI indicative of lower likelihood of NAFLD diagnosis.
S. Tomah: Stock/Shareholder; Self; Amarin Corporation. M. Tasabehji: None. F. Ghazi: None. T. Salah: None. H. Zhang: None. S. Ashrafzadeh: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck & Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC.