Weight boss, dietary advice and statin therapy in non-alcoholic fatty liver disease: a retrospective study

Background: Studies have shown that weight loss can have a favourable effect upon non-alcoholic fatty liver disease (NAFLD). However, the most effective means of achieving weight loss and safety profile of lipid-lowering drugs in the presence of NAFLD is unknown. Aim: To investigate the effect of dietary advice and lipid-lowering drugs, particularly statins, on patients with NAFLD and dyslipidaemia. Design: Observational records based study. Methods: We studied 71 patients with NAFLD and dyslipidaemia diagnosed and treated between 1996 and 2002 at University Hospital Lewisham. Some were referred to a dietician for weight loss advice as part of their management. After treatment all patients were assessed for changes in weight, serum alanine transaminase (ALT) and serum lipids including serum cholesterol, serum high density lipoprotein (HDL) and serum triglycerides. Results: Thirty-seven male and 34 female patients with NAFLD and dyslipidaemia were followed up for a mean period of 440 374 days (median 335), Regression analysis revealed a significant association between changes in weight and changes in serum ALT (p < 0.039). Dietary advice failed to reduce body weight but significantly lowered the serum cholesterol to HDL ratio (p = 0.05). Only 15.4% of patients taking statins experienced a rise in serum ALT >= 40 U/l, and in each case the rise was transient, returning near baseline or below without discontinuation of statin treatment. Conclusions: Weight loss appears to improve NAFLD, and dietary advice and lipid-lowering drugs may be beneficial for patients with NAFLD and dyslipidaemia even if weight loss is not achieved. Statins appear to be safe and efficacious in this group.