Long-term weight changes are associated with initial weight changes after nonalcoholic fatty liver disease diagnosis

Objectives: Weight loss is the mainstay of treatment of NAFLD, but longitudinal data on weight changes and their impact on liver disease are limited. We aimed to characterize weight trajectory up to 5 years of follow-up, effects of weight loss on liver enzyme levels, and predictors of weight loss in NAFLD. Methods: This was a single-center retrospective study of consecutive patients with hepatic steatosis diagnosed on imaging, liver biopsy, or transient elastography between 2010 and 2020. The primary outcome was = 5% weight change at 1-2 years. Secondary outcomes were weight change at 4-5 years and alanine aminotransferase level at 1-2 and 4-5 years. We conducted multivariable logistic regression to identify predictors of = 5% weight loss at 1-2 years. Results: We included 11,559 patients with NAFLD. At year 1-2, 27% had =5% weight loss, whereas 26% had = 5% weight gain. Total 59% and 68% of patients with weight loss and gain, respectively, sustained their weight change by year 4-5. Patients with weight loss at year 1-2 had lower alanine aminotransferase levels at year 1-2 and 4-5. Predictors of = 5% weight loss included female sex, severe obesity, diabetes, and consultation with a dietitian or pharmacist. Conclusions: Over half of patients with NAFLD had = 5% weight loss or gain within 1-2 years, and these changes were usually sustained at 4-5 years. Intensive intervention early after NAFLD diagnosis may result in long-term weight loss and decreased NAFLD disease activity.