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Published in: Digestive Diseases and Sciences 4/2024

Open Access 27-02-2024 | Liver Cirrhosis | Original Article

Bariatric Nutritional Intervention in Obese Patients with Compensated Liver Cirrhosis: A Four-Year Prospective Study

Authors: Zacharias E Kalaitzakis, Emmanuel Giahnakis, Ioannis E Koutroubakis, Ioannis A Mouzas, Evangelos Kalaitzakis

Published in: Digestive Diseases and Sciences | Issue 4/2024

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Abstract

Background

Obesity and liver cirrhosis represent significant health challenges, often leading to various complications.

Aims

This prospective study aimed to investigate the impact of a four-year bariatric intervention, focusing on adherence to the Mediterranean Diet, on anthropometric, hematologic, and biochemical parameters in obese patients with compensated liver cirrhosis. Additionally, the study evaluated the concurrent contribution of weight loss to these health indicators.

Methods

The study involved 62 patients with compensated liver cirrhosis (mean age 65.87 ± 6 years) and 44 healthy controls (mean age 59.11 ± 8 years), all with a BMI > 30 kg/m2. Both groups underwent a weight loss intervention based on the Mediterranean diet, with a four-year follow-up. Anthropometric, biochemical and hematologic parameters were evaluated at several time points during the study and their statistical significance was assessed.

Results

Anthropometric parameters, including weight, BMI, waist and hip circumference, percentage of fat mass, and handgrip strength, exhibited significant improvements (p < 0.05), particularly within the first year of the intervention. Liver function tests and lipid profiles of the patients also showed significant enhancements (p < 0.05). Hematological and biochemical indices, such as hematocrit and ferritin, experienced discreet improvements in the patient cohort (p < 0.05).

Conclusions

This study highlights the potential of a structured bariatric intervention rooted in the Mediterranean diet to positively influence the health of obese patients with compensated liver cirrhosis. The observed improvements in anthropometric, biochemical, and hematologic parameters, particularly within the first year of the intervention, suggest the importance of dietary modifications in managing the health of this patient population.
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Literature
1.
go back to reference Spengler EK, O’Leary JG, Te HS, Rogal S, Pillai AA, Al-Osaimi A et al. Liver Transplantation in the Obese Cirrhotic Patient. Transplantation 2017;101:2288–2296.CrossRefPubMedPubMedCentral Spengler EK, O’Leary JG, Te HS, Rogal S, Pillai AA, Al-Osaimi A et al. Liver Transplantation in the Obese Cirrhotic Patient. Transplantation 2017;101:2288–2296.CrossRefPubMedPubMedCentral
3.
go back to reference Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Morillas R, et al. Portal Hypertension Collaborative Group. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 2011;54:555–61. doi: https://doi.org/10.1002/hep.24418. Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Morillas R, et al. Portal Hypertension Collaborative Group. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 2011;54:555–61. doi: https://​doi.​org/​10.​1002/​hep.​24418.
4.
go back to reference Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G et al. Nutrition and survival in patients with liver cirrhosis. Nutrition 2001;17:445–450.CrossRefPubMed Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G et al. Nutrition and survival in patients with liver cirrhosis. Nutrition 2001;17:445–450.CrossRefPubMed
5.
go back to reference Sam J, Nguyen GC. Protein calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension. Liver Int 2009;29:1396e402. Sam J, Nguyen GC. Protein calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension. Liver Int 2009;29:1396e402.
6.
go back to reference Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Bischoff SC. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019;38:485–521.CrossRefPubMedPubMedCentral Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Bischoff SC. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019;38:485–521.CrossRefPubMedPubMedCentral
11.
go back to reference Gelli C, Tarocchi M, Abenavoli L, Di Renzo L, Galli A, De Lorenzo A. Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease. World J Gastroenterol 2017;23:3150e62. Gelli C, Tarocchi M, Abenavoli L, Di Renzo L, Galli A, De Lorenzo A. Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease. World J Gastroenterol 2017;23:3150e62.
12.
go back to reference Katsagoni CN, Georgoulis M, Papatheodoridis GV, Fragopoulou E, Ioannidou P, Papageorgiou M, et al. Associations between lifestyle characteristics and the presence of nonalcoholic fatty liver disease: a case-control study. Metab Syndrome Relat Disord 2017;15:72e9. Katsagoni CN, Georgoulis M, Papatheodoridis GV, Fragopoulou E, Ioannidou P, Papageorgiou M, et al. Associations between lifestyle characteristics and the presence of nonalcoholic fatty liver disease: a case-control study. Metab Syndrome Relat Disord 2017;15:72e9.
13.
go back to reference Misciagna G, Del Pilar Diaz M, Caramia DV, Bonfiglio C, Franco I, Noviello MR, et al. Effect of a low glycemic index Mediterranean diet on non-alcoholic fatty liver disease. a randomized controlled clinici trial. J Nutr Health Aging 2017;21:404e12. Misciagna G, Del Pilar Diaz M, Caramia DV, Bonfiglio C, Franco I, Noviello MR, et al. Effect of a low glycemic index Mediterranean diet on non-alcoholic fatty liver disease. a randomized controlled clinici trial. J Nutr Health Aging 2017;21:404e12.
14.
go back to reference Perez -Guisado J, Munoz-Serrano A. The effect of the Spanish ketogenic Mediterranean diet on nonalcoholic fatty liver disease: a pilot study. J Med Food 2011;14:677e80. Perez -Guisado J, Munoz-Serrano A. The effect of the Spanish ketogenic Mediterranean diet on nonalcoholic fatty liver disease: a pilot study. J Med Food 2011;14:677e80.
15.
go back to reference Ryan MC, Itsiopoulos C, Thodis T, Ward G, Trost N, Hofferberth S, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol 2013;59:138e43. Ryan MC, Itsiopoulos C, Thodis T, Ward G, Trost N, Hofferberth S, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol 2013;59:138e43.
16.
go back to reference Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229e41. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229e41.
17.
go back to reference Trovato FM, Catalano D, Martines GF, Pace P, Trovato GM. Mediterranean diet and non-alcoholic fatty liver disease: the need of extended and comprehensive interventions. Clin Nutr 2015;34:86e8. Trovato FM, Catalano D, Martines GF, Pace P, Trovato GM. Mediterranean diet and non-alcoholic fatty liver disease: the need of extended and comprehensive interventions. Clin Nutr 2015;34:86e8.
18.
go back to reference Aller R, Izaola O, de la Fuente B, De Luis Roman DA. Mediterranean diet is associated with liver histology in patients with non alcoholic fatty liver disease. Nutr Hosp 2015;32:2518e24. Aller R, Izaola O, de la Fuente B, De Luis Roman DA. Mediterranean diet is associated with liver histology in patients with non alcoholic fatty liver disease. Nutr Hosp 2015;32:2518e24.
19.
go back to reference Della Corte C, Mosca A, Vania A, Alterio A, Iasevoli S, Nobili V. Good adherence to the Mediterranean diet reduces the risk for NASH and diabetes in pediatric patients with obesity: the results of an Italian study. Nutrition 2017;39e40:8e14. Della Corte C, Mosca A, Vania A, Alterio A, Iasevoli S, Nobili V. Good adherence to the Mediterranean diet reduces the risk for NASH and diabetes in pediatric patients with obesity: the results of an Italian study. Nutrition 2017;39e40:8e14.
20.
go back to reference Kontogianni MD, Tileli N, Margariti A, Georgoulis M, Deutsch M, Tiniakos D, et al. Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease. Clin Nutr 2014;33:678e83. Kontogianni MD, Tileli N, Margariti A, Georgoulis M, Deutsch M, Tiniakos D, et al. Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease. Clin Nutr 2014;33:678e83.
21.
go back to reference Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J et al. Nutritional assessment: a comparison of clinical judgement and objective measurements. N Engl J Med 1982;306:969–972.CrossRefPubMed Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J et al. Nutritional assessment: a comparison of clinical judgement and objective measurements. N Engl J Med 1982;306:969–972.CrossRefPubMed
22.
go back to reference Pollock ML, Schmidt DH, Jackson AS. Measurement of cardiorespiratory fitness and body composition in the clinical setting. Compr Ther 1980;6:12–27. Pollock ML, Schmidt DH, Jackson AS. Measurement of cardiorespiratory fitness and body composition in the clinical setting. Compr Ther 1980;6:12–27.
24.
go back to reference Keys A, Aravanis C. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge, MA: Harvard University Press; 1980.CrossRef Keys A, Aravanis C. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge, MA: Harvard University Press; 1980.CrossRef
25.
go back to reference Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–2608.CrossRefPubMed Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–2608.CrossRefPubMed
28.
go back to reference Abenavoli L, Milic N, Peta V, Alfieri F, De Lorenzo A, Bellentani S. Alimentary regimen in non-alcoholic fatty liver disease: Mediterranean diet. World J Gastroenterol 2014;20:16831e40. Abenavoli L, Milic N, Peta V, Alfieri F, De Lorenzo A, Bellentani S. Alimentary regimen in non-alcoholic fatty liver disease: Mediterranean diet. World J Gastroenterol 2014;20:16831e40.
29.
go back to reference Suarez M, Boque N, Del Bas JM, Mayneris-Perxachs J, Arola L, Caimari A. Mediterranean diet and multi-ingredient-based interventions for the management of non-alcoholic fatty liver disease. Nutrients 2017;9:1052.CrossRefPubMedPubMedCentral Suarez M, Boque N, Del Bas JM, Mayneris-Perxachs J, Arola L, Caimari A. Mediterranean diet and multi-ingredient-based interventions for the management of non-alcoholic fatty liver disease. Nutrients 2017;9:1052.CrossRefPubMedPubMedCentral
30.
go back to reference Musso G, Cassader M, Rosina F et al. Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials. Diabetologia 2012;55:885–904.CrossRefPubMed Musso G, Cassader M, Rosina F et al. Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials. Diabetologia 2012;55:885–904.CrossRefPubMed
31.
go back to reference Merli M, Berzigotti A, Zelber-Sagi S et al. EASL clinical practice guidelines on nutrition in chronic liver disease. J Hepatol 2019;70:172–193.CrossRef Merli M, Berzigotti A, Zelber-Sagi S et al. EASL clinical practice guidelines on nutrition in chronic liver disease. J Hepatol 2019;70:172–193.CrossRef
32.
go back to reference Ma J, Hennein R, Liu C, Long MT, Hoffmann U, Jacques PF, et al. Improved diet quality associates with reduction in liver fat, particularly in individuals with high genetic risk scores for nonalcoholic fatty liver disease. Gastroenterology 2018;155:107e17. Ma J, Hennein R, Liu C, Long MT, Hoffmann U, Jacques PF, et al. Improved diet quality associates with reduction in liver fat, particularly in individuals with high genetic risk scores for nonalcoholic fatty liver disease. Gastroenterology 2018;155:107e17.
33.
go back to reference Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis Hepatology. 2010; 51:1445–9. Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis Hepatology. 2010; 51:1445–9.
34.
go back to reference Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology. 2015;149:367–378.CrossRefPubMed Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology. 2015;149:367–378.CrossRefPubMed
35.
go back to reference Berzigotti A, Albillos A, Villanueva C, Genescá J, Ardevol A, Augustín S, et al. Ciberehd SportDiet Collaborative Group. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology. 2017;65:1293–1305. doi: https://doi.org/10.1002/hep.28992. Berzigotti A, Albillos A, Villanueva C, Genescá J, Ardevol A, Augustín S, et al. Ciberehd SportDiet Collaborative Group. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology. 2017;65:1293–1305. doi: https://​doi.​org/​10.​1002/​hep.​28992.
40.
go back to reference Raynard B, Balian A, Fallik D, Capron F, Bedossa P, Chaput JC, Naveau S. Risk factors of fibrosis in alcohol-induced liver disease. Hepatology. 2002;35:635–638.CrossRefPubMed Raynard B, Balian A, Fallik D, Capron F, Bedossa P, Chaput JC, Naveau S. Risk factors of fibrosis in alcohol-induced liver disease. Hepatology. 2002;35:635–638.CrossRefPubMed
41.
go back to reference Ortiz V, Berenguer M, Rayón JM, Carrasco D, Berenguer J. Contribution of obesity to hepatitis C-related fibrosis progression. Am J Gastroenterol. 2002;97:2408–2414.CrossRefPubMed Ortiz V, Berenguer M, Rayón JM, Carrasco D, Berenguer J. Contribution of obesity to hepatitis C-related fibrosis progression. Am J Gastroenterol. 2002;97:2408–2414.CrossRefPubMed
Metadata
Title
Bariatric Nutritional Intervention in Obese Patients with Compensated Liver Cirrhosis: A Four-Year Prospective Study
Authors
Zacharias E Kalaitzakis
Emmanuel Giahnakis
Ioannis E Koutroubakis
Ioannis A Mouzas
Evangelos Kalaitzakis
Publication date
27-02-2024
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 4/2024
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-023-08223-6

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