Multidisciplinary intensive lifestyle intervention improves markers of nonalcoholic fatty liver disease (NAFLD) in patients with type 1 diabetes and obesity: a retrospective matched-cohort study

Shaheen Tomah, Tareq Salah, Marwa Al-Badri, Shilton Dhaver, Hannah Gardner, Mhd Wael Tasabehji, Osama Hamdy, Shaheen Tomah, Tareq Salah, Marwa Al-Badri, Shilton Dhaver, Hannah Gardner, Mhd Wael Tasabehji, Osama Hamdy

Abstract

Background: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing among patients with type 1 diabetes (T1D) paralleling the increasing prevalence of obesity among this population. However, little is known about the impact of intensive lifestyle intervention (ILI) on NAFLD in patients with T1D.

Methods: Using Hepatic Steatosis Index (HSI), a noninvasive surrogate predictor of NAFLD, we retrospectively evaluated 88 adult patients with T1D and obesity after one year of participating in a 12-week ILI program in real-world clinical practice. Using the NAFLD guidelines of the American Association for the Study of Liver Diseases (AASLD), we excluded 11 participants. We matched the remaining ILI cohort (age 43 ± 12 years, females 65%, diabetes duration 22 ± 9 years, A1C 8.2 ± 0.9%, body weight 101 ± 17 kg, BMI 35.3 ± 4.9 kg/m2) in 1:1 ratio with a similar cohort of patients with T1D and obesity who received standard diabetes care (SC) at the same practice and during the same period. Matching criteria included: sex, age, BMI, A1C and duration of T1D. HSI [8 + ALT/AST + BMI (+ 2 if female, + 2 if T2D)] was calculated at baseline and after 12 months of intervention.

Results: At baseline, HSI was similar between the two cohorts (46.2 ± 6.1 in the ILI cohort and 44.9 ± 5.7 in the SC cohort). After 12 months, the ILI group lost an average of 5.6 ± 2.7 kg (5.8%, p < 0.05) while the SC group maintained their baseline body weight (p < 0.001 between groups). HSI decreased significantly from baseline in the ILI group (-2.7 ± 1.1, p = 0.01), but did not change in the SC group (0.6 ± 0.9, p = 0.53, p < 0.001 between groups). Percentage of patients with high likelihood of NAFLD diagnosis decreased from 100% at baseline to 88.3% in the ILI group, and was 10.4% less compared to SC (p < 0.01). Total daily insulin dose decreased in the ILI cohort compared to the SC cohort (-6.1 ± 4.2 versus 1.34 ± 4.3 units/day, p < 0.01).

Conclusions: Twelve weeks of ILI improved HSI and decreased total daily insulin requirements in patients with T1D and obesity at one year. Short-term ILI should be implemented in the management of NAFLD for obese patients with type 1 diabetes.

Keywords: Lifestyle intervention; Liver fibrosis; NAFLD; Obesity; Type 1 Diabetes; Weight management.

Conflict of interest statement

OH receives research support from National Dairy Council, Eli Lilly and Company, and Novo Nordisk; consults for Merck Inc., Sanofi-Aventis and Abbott Nutrition; is on the advisory board of Astra Zeneca Inc. and is a shareholder of Healthimation Inc. None of these entities supported this research in part or total. ST, TS, MA, SD, HG and MWT have no disclosures relevant to this work.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Changes in (A) body weight and (B) total daily insulin dose after 1 year. Data are mean±SD. ILI, Intensive lifestyle intervention; SC, Standard diabetes care. n=77 in each cohort
Fig. 2
Fig. 2
Change in HSI, body weight, and daily basal insulin dose after 1 year. Legend. A Association between change in HSI and change in body weight after 1 year in response to ILI and SC in the total cohort. B Association between change in HSI and daily basal insulin dose after 1 year in response to ILI and SC in the total cohort. HSI, Hepatic steatosis index; ILI, Intensive lifestyle intervention; SC, Standard diabetes care. N=154
Fig. 3
Fig. 3
Likelihood of NAFLD diagnosis after 1 year ILI and SC. Data are %. n=77 in each cohort. NAFLD, nonalcoholic fatty liver disease. ‡ High likelihood of NAFLD diagnosis defined as having HSI>36. HSI>36 can detect NAFLD with a specificity of 92.4% and a positive likelihood ratio of 6.069

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