Impact of weight loss and lifestyle modifications on liver fibrosis in MASLD and MetALD: A cohort study

The present study aimed to investigate the impact of weight loss and abstinence and exercise on liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatotic liver disease and alcoholic-related liver disease (MetALD). A total of 67 patients with MASLD and 33 patients with MetALD were retrospectively evaluated after six months of follow-up for weight loss, abstinence and exercise. A decrease in liver fibrosis (decrease in dLSM2B) was defined as a reduction in liver stiffness (LS) by FibroScan and macrophage galactose-specific lectin-2 binding protein glycosylation isomer (M2BPGi) over the observation period. The decrease in dLSM2B levels was 35.8 and 39.4% in the MASLD and MetALD groups, respectively. In MASLD, the decreased weight rate (dBW%) was lower for a decrease in dLSM2B than for an increase. However, in MetALD, the dBW% was not significantly different between the groups. In MetALD, patients with complete abstinence and exercise frequency had a higher rate of decrease in dLSM2B. A prediction score of 0, 1 or 2 points was developed to predict the decrease in dLSM2B, with 1 point awarded for a dBW% reduction of ≥3.8 and 1 point for a FIB-4 reduction of ≥0.201. In patients with MASLD, there was a significant difference in the decrease in dLSM2B by 8.3% for a prediction score of 0, 36% for 1, and 72.2% for 2 points, whereas there was no significant difference in the improvement rate for 0-2 points. In conclusion, weight loss during MASLD and abstinence and exercise during MetALD were associated with a decrease in dLSM2B.