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      Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study

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          Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis.

          Àngels Escorsell, D. Grace, Antonio J. Pagán … (2005)
          Nonselective beta-adrenergic blockers decrease portal pressure and prevent variceal hemorrhage. Their effectiveness in preventing varices is unknown. We randomly assigned 213 patients with cirrhosis and portal hypertension (minimal hepatic venous pressure gradient [HVPG] of 6 mm Hg) to receive timolol, a nonselective beta-blocker (108 patients), or placebo (105 patients). The primary end point was the development of gastroesophageal varices or variceal hemorrhage. Endoscopy and HVPG measurements were repeated yearly. During a median follow-up of 54.9 months, the rate of the primary end point did not differ significantly between the timolol group and the placebo group (39 percent and 40 percent, respectively; P=0.89), nor were there significant differences in the rates of ascites, encephalopathy, liver transplantation, or death. Serious adverse events were more common among patients in the timolol group than among those in the placebo group (18 percent vs. 6 percent, P=0.006). Varices developed less frequently among patients with a baseline HVPG of less than 10 mm Hg and among those in whom the HVPG decreased by more than 10 percent at one year and more frequently among those in whom the HVPG increased by more than 10 percent at one year. Nonselective beta-blockers are ineffective in preventing varices in unselected patients with cirrhosis and portal hypertension and are associated with an increased number of adverse events. (ClinicalTrials.gov number, NCT00006398.) Copyright 2005 Massachusetts Medical Society.
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            Effect of degree of weight loss on health benefits.

            Brian G. Blackburn (1995)
            Although most dieters strive to achieve "ideal" body weight, clinical and laboratory evidence clearly supports the value of a modest weight loss goal to attain health and emotional benefit. Weight loss as low as 5% has been shown to reduce or eliminate disorders associated with obesity, though several questions remain partially or completely unanswered regarding the roles of degree of weight loss, method of weight loss, distribution of fat reduction, and other variables. This paper reviews the effect of degree of weight loss on specific disease states and risk factors and discusses the impact of ethnic background, fat distribution, age, and mode of weight loss on outcome.
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              Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis

              Annalisa Berzigotti, Guadalupe Garcia-Tsao, Jaime Bosch … (2011)
              Obesity is associated with an aggressive course in chronic viral hepatitis; however, its impact in the development of clinical decompensation (CD) in patients with established cirrhosis is uncertain. We evaluated the role of obesity, in relationship to other recognized predictors, in the development of CD in patients with compensated cirrhosis. The study population, a subset of patients included in a randomized trial of beta-blockers in the prevention of varices in whom data on body mass index (BMI) was available, consisted of 161 patients with compensated cirrhosis. Laboratory tests and portal pressure (assessed by the hepatic venous pressure gradient or HVPG) were assessed on inclusion. Patients were followed until CD (ascites, hepatic encephalopathy, or variceal hemorrhage), or until September 2002. Altogether, 29% had a normal BMI, 40% were overweight, and 30% were obese. In a median follow-up of 59 months, CD occurred in 48/161 (30%) patients with an increasingly higher rate according to BMI group (15% in those with normal BMI; 31% in overweight; 43% in obese patients, P=0.011). The actuarial probability of developing CD was significantly higher in the abnormal BMI groups (P=0.022). In a multivariate model that included parameters previously identified as being predictive of CD (HVPG, albumin, Mayo endstage liver disease score), etiology, and treatment group, BMI (hazard ration 1.06; 95% confidence interval 1.01-1.12), P=0.02] was an independent predictor of decompensation, together with HVPG and albumin. Obesity has a deleterious effect on the natural history of compensated cirrhosis of all etiologies, independent of portal pressure and liver function. Weight reduction may be a valuable therapeutic measure in this patient population. Copyright © 2011 American Association for the Study of Liver Diseases.
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                Author and article information

                Journal
                Title: Hepatology
                Abbreviated Title: Hepatology
                Publisher: Wiley-Blackwell
                ISSN: 02709139
                Publication date Created: April 2017
                Publication date (Print): April 2017
                Volume: 65
                Issue: 4
                Pages: 1293-1305
                Affiliations
                [1 ]on behalf of the Ciberehd SportDiet Collaborative Group
                Article
                DOI: 10.1002/hep.28992
                PubMed ID: 27997989
                SO-VID: 55ae5f2d-d5b6-4f55-859c-d01caefc7cc2
                Copyright © © 2017
                License:

                http://doi.wiley.com/10.1002/tdm_license_1

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