Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life

Background and aim: Obesity is a risk factor for progression of fibrosis in chronic liver diseases such as non-alcoholic fatty liver disease and hepatitis C. The aim of this study was to investigate the longer term effect of weight loss on liver biochemistry, serum insulin levels, and quality of life in overweight patients with liver disease and the effect of subsequent weight maintenance or regain. Patients: Thirty one patients completed a 15 month diet and exercise intervention. Results: On completion of the intervention, 21 patients (68%) had achieved and maintained weight loss with a mean reduction of 9.4 (4.0)% body weight. Improvements in serum alanine aminotransferase (ALT) levels were correlated with the amount of weight loss (r=0.35, p=0.04). In patients who maintained weight loss, mean ALT levels at 15 months remained significantly lower than values at enrolment (p=0.004), while in regainers (n=10), mean ALT levels at 15 months were no different to values at enrolment (p=0.79). Improvements in fasting serum insulin levels were also correlated with weight loss (r=0.46, p=0.04), and subsequent weight maintenance sustained this improvement. Quality of life was significantly improved after weight loss. Weight maintainers sustained recommended levels of physical activity and had higher fasting insulin levels (p=0.03) at enrolment than weight regainers. Conclusion: In summary, these findings demonstrate that maintenance of weight loss and exercise in overweight patients with liver disease results in a sustained improvement in liver enzymes, serum insulin levels, and quality of life. Treatment of overweight patients should form an important component of the management of those with chronic liver disease.

Dietary carbohydrate source affects glucose concentrations, insulin secretion, and food intake in overweight cats

This study was undertaken to assess the impact of dietary carbohydrate source on food intake, body composition, glucose tolerance, insulin sensitivity, and glucose and insulin concentrations in overweight and obese cats with reduced insulin sensitivity. Sixteen overweight and obese cats were divided into two groups and randomly allocated one of two extruded diets formulated to contain similar starch content (33%) from different cereal sources (sorghum and corn versus rice). Meal response, glucose tolerance and insulin sensitivity tests were performed before and after a 6-week weight-maintenance phase and after an additional 8-week free-access feeding phase. Dual energy x-ray absorptiometry (DEXA)-derived body composition was determined in each cat before the study and after each test phase. Food intake was measured daily and body weight measured twice weekly for the duration of the study. When compared with the sorghum/corn-based diet, cats fed the rice-based diet consumed more energy and gained more weight in response to free-access feeding. Cats fed the rice-based diet also tended to have higher glucose concentrations and insulin secretion in response to a glucose load or a test meal. We conclude that a sorghum and corn blend is a superior carbohydrate source than rice for overweight cats with glucose intolerance and reduced insulin sensitivity. Such a diet may help to minimize overeating and additional weight gain, and may also reduce the risk of developing type 2 diabetes mellitus. (C) 2004 Elsevier Inc. All rights reserved.