Original Contribution
The American Journal of Gastroenterology (2005) 100, 1072–1081; doi:10.1111/j.1572-0241.2005.41334.x
One-Year Intense Nutritional Counseling Results in Histological Improvement in Patients with Non-Alcoholic Steatohepatitis: A Pilot Study
Mary Ann Huang MD, MS1, Joel K Greenson MD1, Cewin Chao RD1, Lilian Anderson MS, RD1, Debra Peterman RD1, Jon Jacobson MD1, Dawn Emick BS1, Anna S Lok MD1 and Hari S Conjeevaram MD, MS1
1Division of Gastroenterology, Department of Internal Medicine; Department of Pathology; General Clinical Research Center; Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
Correspondence: Hari Conjeevaram, MD, MS, Assistant Professor of Medicine, Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0362
Received 11 August 2004; Revised 0000; Accepted 6 December 2004.
Abstract
BACKGROUND AND AIM:
In individuals with biopsy-proven non-alcoholic steatohepatitis (NASH), short-term weight loss has been shown to improve biochemical abnormalities; however, its effect on liver histology is largely unknown. The aim of the article is to determine if dietary intervention is effective in improving histological features of steatohepatitis in patients with biopsy-proven NASH.
METHODS:
Twenty-three patients (11M/12F) with BMI >25 kg/m2 and biopsy-proven NASH received standardized nutritional counseling aimed at reducing insulin resistance (IR) and weight. Blood tests were checked at baseline and every 1–4 months, and liver biopsy was repeated at month 12. IR was assessed by the homeostasis model assessment (HOMA). Liver biopsies were scored according to modified Brunt criteria for NASH. "Histologic response" was defined as a reduction in total NASH score of 
2 points with at least one point being in the non-steatosis component.
RESULTS:
Sixteen patients (8M/8F) completed 12 months of dietary intervention, and 15 underwent repeat liver biopsies. At month 12, mean weight decreased from 98.3 to 95.4 kg. Mean waist circumference, visceral fat, fasting glucose, IR, triglycerides, AST, ALT, and histologic score were all reduced but the difference was not significant. Nine patients had a histologic response, six had stable scores, and none had a worsened score. Compared to patients with unchanged histologic scores, patients with improved scores had significantly greater reduction in weight, waist circumference, AST, ALT, steatosis grade, and total NASH score.
CONCLUSION:
Among patients who successfully completed 1 yr of intense dietary intervention, nine of 15 patients with NASH displayed histologic improvement. This pilot study suggests that dietary intervention can be effective in improving histology in patients with biopsy-proven NASH.
