Liver Enzyme Spike After Weight Loss Deemed Transient

PHOENIX — Increases in liver enzymes after substantial weight loss are common, transient, and not cause for alarm, suggest study results presented at the annual scientific meeting of the Obesity Society.

Dr. James W. Anderson assessed liver function tests in 91 obese and 94 severely obese patients who were participating in a rapid weight loss program at the University of Kentucky, Lexington, where he is medical director of the Health Management Resources weight loss program.

About a quarter of both groups had elevated alanine aminotransferase (ALT) levels at baseline. Mean ALT levels increased within 3-6 weeks of starting the program in nearly all patients. By 16 weeks, however, ALT levels had returned to normal in 98% of the population.

“What we found systematically is that the levels increase, but they come back down below where they started. So we think this is therapeutic, of great value,” he said in a poster-side interview, rejecting the hypothesis that weight loss could trigger or worsen liver disease.

Generally speaking, about a third of obese individuals have elevated ALT before weight loss, Dr. Anderson said. Moreover, approximately two-thirds of obese individuals and about 90% of severely obese individuals have steatosis, according to one report (N. Engl. J. Med. 2002;346:1221).

The 91 obese individuals studied by Dr. Anderson had a baseline body mass index of 42 kg/m

Less than half, 47%, of the 94 severely obese individuals were women, and the group was slightly younger with an average age of 43 years. The severely obese cohort started with a baseline BMI of 53 kg/m

Dr. Anderson reported that in 70 severely obese patients with baseline ALT values of 40 U/L or less, those values rose from 25 U/L to 60 U/L at 6 weeks but then fell to 30 U/L at 16 weeks and were below baseline at 40 weeks. The mean peak and final ALT values in this group were 81 U/L and 24 U/L, respectively.

Another 24 severely obese patients had abnormal initial ALT values that increased from 61 U/L to 81 U/L at 2 weeks before falling to 34 U/L by 16 weeks. The mean peak and final ALT values in this group were 97 U/L and 28 U/L, respectively.

In the obese group, the changes were not as dramatic, but a similar pattern was observed. In these patients, the initial ALTvalue was 33 U/L, and the final value fell to 29 U/L.

“These observations suggest most of our patients had benign steatosis that benefited from rapid and significant weight loss,” the authors concluded in the poster.

Dr. Anderson speculated that liver enzyme levels might go up when people start losing weight because fat moves out of the liver so fast that “it drags some enzymes with it.”

To prove benefit conclusively would require biopsy data, and that would require an unnecessary invasive procedure, he added.

“We think we are doing a good thing here, but this is clinical judgment,” he said. “We don't have solid biopsy data.”

Dr. Anderson disclosed no conflicts of interest.

'Most of our patients had benign steatosis that benefited from rapid and significant weight loss.' DR. ANDERSON

PHOENIX — Increases in liver enzymes after substantial weight loss are common, transient, and not cause for alarm, suggest study results presented at the annual scientific meeting of the Obesity Society.

Dr. James W. Anderson assessed liver function tests in 91 obese and 94 severely obese patients who were participating in a rapid weight loss program at the University of Kentucky, Lexington, where he is medical director of the Health Management Resources weight loss program.

About a quarter of both groups had elevated alanine aminotransferase (ALT) levels at baseline. Mean ALT levels increased within 3-6 weeks of starting the program in nearly all patients. By 16 weeks, however, ALT levels had returned to normal in 98% of the population.

“What we found systematically is that the levels increase, but they come back down below where they started. So we think this is therapeutic, of great value,” he said in a poster-side interview, rejecting the hypothesis that weight loss could trigger or worsen liver disease.

Generally speaking, about a third of obese individuals have elevated ALT before weight loss, Dr. Anderson said. Moreover, approximately two-thirds of obese individuals and about 90% of severely obese individuals have steatosis, according to one report (N. Engl. J. Med. 2002;346:1221).

The 91 obese individuals studied by Dr. Anderson had a baseline body mass index of 42 kg/m

Less than half, 47%, of the 94 severely obese individuals were women, and the group was slightly younger with an average age of 43 years. The severely obese cohort started with a baseline BMI of 53 kg/m

Dr. Anderson reported that in 70 severely obese patients with baseline ALT values of 40 U/L or less, those values rose from 25 U/L to 60 U/L at 6 weeks but then fell to 30 U/L at 16 weeks and were below baseline at 40 weeks. The mean peak and final ALT values in this group were 81 U/L and 24 U/L, respectively.

Another 24 severely obese patients had abnormal initial ALT values that increased from 61 U/L to 81 U/L at 2 weeks before falling to 34 U/L by 16 weeks. The mean peak and final ALT values in this group were 97 U/L and 28 U/L, respectively.

In the obese group, the changes were not as dramatic, but a similar pattern was observed. In these patients, the initial ALTvalue was 33 U/L, and the final value fell to 29 U/L.

“These observations suggest most of our patients had benign steatosis that benefited from rapid and significant weight loss,” the authors concluded in the poster.

Dr. Anderson speculated that liver enzyme levels might go up when people start losing weight because fat moves out of the liver so fast that “it drags some enzymes with it.”

To prove benefit conclusively would require biopsy data, and that would require an unnecessary invasive procedure, he added.

“We think we are doing a good thing here, but this is clinical judgment,” he said. “We don't have solid biopsy data.”

Dr. Anderson disclosed no conflicts of interest.

'Most of our patients had benign steatosis that benefited from rapid and significant weight loss.' DR. ANDERSON

PHOENIX — Increases in liver enzymes after substantial weight loss are common, transient, and not cause for alarm, suggest study results presented at the annual scientific meeting of the Obesity Society.

Dr. James W. Anderson assessed liver function tests in 91 obese and 94 severely obese patients who were participating in a rapid weight loss program at the University of Kentucky, Lexington, where he is medical director of the Health Management Resources weight loss program.

About a quarter of both groups had elevated alanine aminotransferase (ALT) levels at baseline. Mean ALT levels increased within 3-6 weeks of starting the program in nearly all patients. By 16 weeks, however, ALT levels had returned to normal in 98% of the population.

“What we found systematically is that the levels increase, but they come back down below where they started. So we think this is therapeutic, of great value,” he said in a poster-side interview, rejecting the hypothesis that weight loss could trigger or worsen liver disease.

Generally speaking, about a third of obese individuals have elevated ALT before weight loss, Dr. Anderson said. Moreover, approximately two-thirds of obese individuals and about 90% of severely obese individuals have steatosis, according to one report (N. Engl. J. Med. 2002;346:1221).

The 91 obese individuals studied by Dr. Anderson had a baseline body mass index of 42 kg/m

Less than half, 47%, of the 94 severely obese individuals were women, and the group was slightly younger with an average age of 43 years. The severely obese cohort started with a baseline BMI of 53 kg/m

Dr. Anderson reported that in 70 severely obese patients with baseline ALT values of 40 U/L or less, those values rose from 25 U/L to 60 U/L at 6 weeks but then fell to 30 U/L at 16 weeks and were below baseline at 40 weeks. The mean peak and final ALT values in this group were 81 U/L and 24 U/L, respectively.

Another 24 severely obese patients had abnormal initial ALT values that increased from 61 U/L to 81 U/L at 2 weeks before falling to 34 U/L by 16 weeks. The mean peak and final ALT values in this group were 97 U/L and 28 U/L, respectively.

In the obese group, the changes were not as dramatic, but a similar pattern was observed. In these patients, the initial ALTvalue was 33 U/L, and the final value fell to 29 U/L.

“These observations suggest most of our patients had benign steatosis that benefited from rapid and significant weight loss,” the authors concluded in the poster.

Dr. Anderson speculated that liver enzyme levels might go up when people start losing weight because fat moves out of the liver so fast that “it drags some enzymes with it.”

To prove benefit conclusively would require biopsy data, and that would require an unnecessary invasive procedure, he added.

“We think we are doing a good thing here, but this is clinical judgment,” he said. “We don't have solid biopsy data.”

Dr. Anderson disclosed no conflicts of interest.

'Most of our patients had benign steatosis that benefited from rapid and significant weight loss.' DR. ANDERSON