Body fat reduction as a predictor for liver steatosis regression in obese patients: An interim analysis of the DocWeight 2.3 behavioral weight loss program

Background: In persons with obesity, behavioral weight loss (BWL) programs can significantly reduce weight and improve comorbidities like metabolic-dysfunction associated steatotic liver disease (MASLD). However, in this population, diagnosing MASLD via ultrasound is often difficult due to anthropometric factors including increased body fat mass. Data on the usefulness of ultrasound techniques for longitudinal MASLD monitoring in relation to changes in body composition is scarce ([1]). In this interim analysis, we investigated the relationship between changes in body composition of participants of the DocWeight 2.3 evaluation study, a one-year BWL intervention with intensive dietary counseling, cognitive behavioral therapy and physical activity, and multiparametric ultrasound-based assessment of MASLD.

Methods: Participants were randomized 1:1:1 into three groups: the DocWeight 2.3 program with an initial eight-week formula diet phase, the program without formula phase or a control group with minimal treatment (five sessions of dietary counseling in one year). We analyzed the different ultrasound techniques for liver steatosis assessment ultrasound-derived fat fraction (UDFF, Siemens Healthineers, Erlangen, Germany), controlled attenuation parameter (CAP, Echosens, Paris, France) and attenuation imaging (Canon Medical Systems, Ota, Japan) performed at baseline and after 6 months of the study. A linear mixed model (LMM) was used to identify predictors of CAP, UDFF and ATI changes.

Results: For this interim analysis, data were collected from 37 patients (62% female, median [1st; 3rd quartile] age 49 [37; 59] years, body mass index 38.9 [34.7; 43.2] kg/m²). Median [95% confidence interval] weight change for all patients participating in the study after 6 months was -7.6 [-9.5; -3.8] kg (6 months vs. baseline p<0.001), body fat mass change was -6.4 [-8.2; -3.7] kg (p<0.001) and muscle mass change 0.2 [-0.07; 0.4] kg (p=0.5). Overall, 21 participants lost>5 kg body weight, which is generally considered as clinically meaningful ([2]), 7 participants lost 0-5 kg body weight and 8 patients gained weight (1.1-6.6 kg; one dropout). The LMM analysis indicated body fat reduction as a predictor of CAP (p=0.005) and UDFF (p=0.01) decreases, but not of ATI (p=0.1).

Discussion: We found significant reductions in body weight and fat mass for most patients participating in the study, while muscle mass remained stable. This differs from the typical muscle mass losses associated with glucagon-like peptide-1 agonist therapy or bariatric surgery ([3]). We identified body fat reduction as a key predictor of improved ultrasound assessment of liver steatosis when measured by CAP or UDFF. This insight could help to monitor weight loss therapy effects in MASLD patients on liver health. We aim to validate those findings in larger cohorts and explore the potential of ultrasound techniques for longitudinal MASLD monitoring in routine clinical practice.

Publikationsverlauf

Artikel online veröffentlicht:
28. Mai 2025

• Literatur

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• 2 American Diabetes Association Professional Practice Committee. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes. Diabetes Care 2022; 45: S113-24
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