Venesection for non-alcoholic fatty liver disease unresponsive to lifestyle counselling—a propensity score-adjusted observational study

To test the short-term clinical usefulness of venesection associated with lifestyle counselling as against counselling alone on insulin resistance and liver enzymes in subjects with non-alcoholic fatty liver disease (NAFLD), using a propensity score approach. We carried out a 6- to 8-month observati...

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Bibliographic Details
Published in:QJM : An International Journal of Medicine 2011-02, Vol.104 (2), p.141-149
Main Authors: VALENTI, L, MOSCATIELLO, S, VANNI, E, FRACANZANI, A. L, BUGIANESI, E, FARGION, S, MARCHESINI, G
Format: Article
Language:English
Subjects:
Adult
Alanine Transaminase - blood
Anthropometry
Biological and medical sciences
Body Mass Index
Counseling
Epidemiologic Methods
Fatty Liver - physiopathology
Fatty Liver - surgery
Fatty Liver - therapy
Female
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Insulin Resistance - physiology
Life Style
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Non-alcoholic Fatty Liver Disease
Other diseases. Semiology
Phlebotomy
Treatment Failure
Treatment Outcome
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Summary:To test the short-term clinical usefulness of venesection associated with lifestyle counselling as against counselling alone on insulin resistance and liver enzymes in subjects with non-alcoholic fatty liver disease (NAFLD), using a propensity score approach. We carried out a 6- to 8-month observational analysis of 198 NAFLD patients in three Italian referral centres (79 venesection and 119 counselling alone). Insulin resistance was measured by the homeostasis model assessment (HOMA) method. Logistic regression was used to identify factors associated with normal HOMA and normal alanine aminotransferase (ALT) at the end of observation. The results were adjusted for the propensity score to be enrolled in the venesection programme, based on clinical and laboratory data, including common HFE polymorphisms and liver biopsy (available in 161 cases). After adjustment for propensity and changes in BMI, venesection was significantly associated with normal HOMA [all cases: odds ratio (OR) 3.00; 95% confidence interval (CI) 1.51-5.97; cases with histology: OR 2.29; 95% CI 1.08-4.87] and ALT within normal limits (all cases: OR 2.56; 95% CI 1.29-5.10; cases with histology: OR 2.81; 95% CI 1.20-5.24). The results were confirmed in an analysis of 57 pairs matched for propensity, where venesection similarly increased the probability of normal HOMA (OR 3.27; 95% CI 1.16-7.84) and normal ALT (OR 5.60; 95% CI 2.09-15.00). Similar data were obtained in the subset of cases with normal basal ferritin (
ISSN:1460-2725
1460-2393
DOI:10.1093/qjmed/hcq170