See the published version of this preprint at Nutrition & Metabolism.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
Research
Francis Martin Finucane
Galway University Hospitals
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5374-7090
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction: Excess adiposity is associated with fat accumulation within the liver, and non-alcoholic steatohepatitis (NASH) is highly prevalent in bariatric patients. Elevated alanine aminotransferase (ALT) is associated with prevalent NASH. We sought to determine the influence of a milk-based meal replacement weight-loss programme on ALT levels in adults with severe and complicated obesity.
Methods: We conducted a retrospective cohort study of patients who completed a 24-week meal replacement programme, comprised of a weight loss phase followed by weight stabilisation and maintenance phases, each eight weeks long. ALT was quantified using an enzymatic assay with spectrophotometric detection. We examined changes over time in ALT using the non-parametric Wilcoxon singed-rank test and the Friedman test.
Results: Of 105 patients, 56 were female, mean age was 51.2±11.2 (range 18.0-71.6) years. There was an unanticipated but transient increase in ALT from 28.0 [20.0, 40.5] iu/l at baseline to 40.0 [26.0, 55.0] iu/l after two weeks (p<0.0005), followed by a gradual reduction to 21.0 [17.0, 28.3] iu/l by 24 weeks (p<0.0005). The overall reductions in ALT were more pronounced in patients who had elevated levels at baseline. Body weight decreased from 144.2±28.0 kg at baseline to 121.6±25.4 kg at 24 weeks (p<0.0005) and body mass index (BMI) decreased from 50.7±8.1 kg m-2 at baseline to 43.0±7.6 kg m-2 by 24 weeks (p<0.0005).
Conclusion: In adults with severe and complicated obesity undergoing a milk-based meal replacement programme, there was an initial unanticipated rise in ALT in the first two weeks, followed by a gradual overall reduction by 24 weeks. These findings suggest that rapid weight loss secondary to significant caloric restriction might induce a transient deterioration in hepatic steatosis prior to an ultimate overall improvement.
Keywords
Non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, alanine aminotransferase, severe obesity, milk-based meal replacement programme, bariatric
Figure 1
Loading...
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Nutrition & Metabolism.
Version 2
Posted 16 Sep, 2020
No community comments so far
Editorial decision: Accept
On 07 Oct, 2020
Reviewer #2 agreed
On 21 Sep, 2020
Review #2 received
Received 21 Sep, 2020
Review #1 received
Received 20 Sep, 2020
Editor assigned
On 14 Sep, 2020
Reviewers invited
Invitations sent on 14 Sep, 2020
Reviewer #1 agreed
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 11 Aug, 2020
Review #2 received
Received 06 Aug, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
Reviewer #1 agreed
On 06 Aug, 2020
Reviewer #2 agreed
On 06 Aug, 2020
Review #1 received
Received 06 Aug, 2020
Editor assigned
On 01 Jul, 2020
Editor invited
On 30 Jun, 2020
Submission checks complete
On 09 May, 2020
First submitted
On 03 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Nutrition & Metabolism.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Francis Martin Finucane
Galway University Hospitals
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5374-7090
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Nutrition & Metabolism.
Version 2
Posted 16 Sep, 2020
No community comments so far
Editorial decision: Accept
On 07 Oct, 2020
Reviewer #2 agreed
On 21 Sep, 2020
Review #2 received
Received 21 Sep, 2020
Review #1 received
Received 20 Sep, 2020
Editor assigned
On 14 Sep, 2020
Reviewers invited
Invitations sent on 14 Sep, 2020
Reviewer #1 agreed
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 11 Aug, 2020
Review #2 received
Received 06 Aug, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
Reviewer #1 agreed
On 06 Aug, 2020
Reviewer #2 agreed
On 06 Aug, 2020
Review #1 received
Received 06 Aug, 2020
Editor assigned
On 01 Jul, 2020
Editor invited
On 30 Jun, 2020
Submission checks complete
On 09 May, 2020
First submitted
On 03 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Nutrition & Metabolism.
Introduction: Excess adiposity is associated with fat accumulation within the liver, and non-alcoholic steatohepatitis (NASH) is highly prevalent in bariatric patients. Elevated alanine aminotransferase (ALT) is associated with prevalent NASH. We sought to determine the influence of a milk-based meal replacement weight-loss programme on ALT levels in adults with severe and complicated obesity.
Methods: We conducted a retrospective cohort study of patients who completed a 24-week meal replacement programme, comprised of a weight loss phase followed by weight stabilisation and maintenance phases, each eight weeks long. ALT was quantified using an enzymatic assay with spectrophotometric detection. We examined changes over time in ALT using the non-parametric Wilcoxon singed-rank test and the Friedman test.
Results: Of 105 patients, 56 were female, mean age was 51.2±11.2 (range 18.0-71.6) years. There was an unanticipated but transient increase in ALT from 28.0 [20.0, 40.5] iu/l at baseline to 40.0 [26.0, 55.0] iu/l after two weeks (p<0.0005), followed by a gradual reduction to 21.0 [17.0, 28.3] iu/l by 24 weeks (p<0.0005). The overall reductions in ALT were more pronounced in patients who had elevated levels at baseline. Body weight decreased from 144.2±28.0 kg at baseline to 121.6±25.4 kg at 24 weeks (p<0.0005) and body mass index (BMI) decreased from 50.7±8.1 kg m-2 at baseline to 43.0±7.6 kg m-2 by 24 weeks (p<0.0005).
Conclusion: In adults with severe and complicated obesity undergoing a milk-based meal replacement programme, there was an initial unanticipated rise in ALT in the first two weeks, followed by a gradual overall reduction by 24 weeks. These findings suggest that rapid weight loss secondary to significant caloric restriction might induce a transient deterioration in hepatic steatosis prior to an ultimate overall improvement.
Figure 1
Loading...