Nițescu Maria 1, 2, Săndulescu Oana 1, 2, Pițigoi Daniela 1, 2, Streinu-Cercel Anca 1, 2, Streinu-Cercel A. 1, 2
1 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
2 National Institute for Infectious Diseases”Prof. Dr. Matei Balș”, Bucharest
Abstract
Steatohepatitis is an important concern in patients who are overweight or obese. A 63 year-old male patient presented to our clinic for investigation of asymptomatic low-grade cytolysis. His medical history included ongoing class 2 obesity, arterial hypertension, and metabolic syndrome. Clinical exam showed obesity (body mass index 37.2 kg/sqm, waist-hip ratio 0.97), fatigue, and dyspnea on exertion. FibroMax identified severe steatosis (S3, N1), advanced fibrosis (F3) and important necroinflammatory activity (A3). Steatohepatitis was diagnosed, common viral causes of liver disease were excluded, and a complete nutritional evaluation was performed, with identification of modifiable lifestyle risk factors for fatty liver disease. We designed a personalized lifestyle and nutritional intervention that consisted of a balanced hypocaloric diet of 1800 kcal/day initially and then gradually increased to 2000 kcal/day. The patient was motivated by timely weight loss, disappearance of fatigue and dyspnea, and remained highly adherent to the intervention. At his 8 months follow-up, he had lost 33.5 kg, and the percent body fat had decreased from 35.8% to 20.1%, paralleled by decrease in visceral fat. He had reached a body mass index of 28.2 kg/ sqm, a fitness score of 88 points, with normal biochemistry and lipid profile results. FibroMax showed significant improvement, with almost no residual necroinflammatory activity (A0-A1), two-fold decrease on SteatoTest (now at S0-S1), and two-fold decrease in NASHTest (now at N0). The patient will return for follow-up at 12 months. In conclusion, personalized lifestyle and nutritional interventions coupled with achievable targets can be useful in the management of steatohepatitis.