Excess adiposity is associated with fat accumulation within the liver, and non-alcoholic steatohepatitis (NASH) is highly prevalent in bariatric patients. Elevated alanine aminotransferase (ALT) is associated with prevalent NASH. We sought to determine the influence of a milk-based meal replacement weight-loss programme on ALT levels in adults with severe and complicated obesity. We conducted a retrospective cohort study of patients who completed a 24-week meal replacement programme, comprised of a weight loss phase followed by weight stabilisation and maintenance phases, each 8 weeks long. ALT was quantified using an enzymatic assay with spectrophotometric detection. We examined changes over time in ALT using the non-parametric Wilcoxon singed-rank test and the Friedman test. Of 105 patients, 56 were female, mean age was 51.2 ± 11.2 (range 18.0–71.6) years. There was an unanticipated but transient increase in ALT from 28.0 [20.0, 40.5] iu/L at baseline to 40.0 [26.0, 55.0] iu/L after 2 weeks (p < 0.0005), followed by a gradual reduction to 21.0 [17.0, 28.3] iu/L by 24 weeks (p < 0.0005). The overall reductions in ALT were more pronounced in patients who had elevated levels at baseline. Body weight decreased from 144.2 ± 28.0 kg at baseline to 121.6 ± 25.4 kg at 24 weeks (p < 0.0005) and body mass index (BMI) decreased from 50.7 ± 8.1 kg m−2 at baseline to 43.0 ± 7.6 kg m−2 by 24 weeks (p < 0.0005). In adults with severe and complicated obesity undergoing a milk-based meal replacement programme, there was an initial unanticipated rise in ALT in the first 2 weeks, followed by a gradual overall reduction by 24 weeks. These findings suggest that rapid weight loss secondary to significant caloric restriction might induce a transient deterioration in hepatic steatosis prior to an ultimate overall improvement.

中文翻译：

---

在以牛奶为基础的代餐计划中，患有严重和复杂性肥胖的成年人丙氨酸氨基转移酶的变化

过度肥胖与肝脏内的脂肪堆积有关，非酒精性脂肪性肝炎 (NASH) 在减肥患者中非常普遍。升高的丙氨酸氨基转移酶 (ALT) 与流行的 NASH 相关。我们试图确定以牛奶为基础的代餐减肥计划对患有严重和复杂肥胖的成年人的 ALT 水平的影响。我们对完成为期 24 周的代餐计划的患者进行了一项回顾性队列研究，该计划包括减肥阶段，随后是体重稳定和维持阶段，每 8 周一次。使用具有分光光度检测的酶测定来量化ALT。我们使用非参数 Wilcoxon singed-rank 检验和弗里德曼检验检查了 ALT 随时间的变化。在 105 名患者中，56 名女性，平均年龄为 51.2 ± 11.2（范围 18. 0-71.6) 年。ALT 从基线的 28.0 [20.0, 40.5] iu/L 到 2 周后的 40.0 [26.0, 55.0] iu/L 出现出乎意料但短暂的升高（p < 0.0005），随后逐渐降低至 21.0 [17.0, 28.3] iu/L 到 24 周 (p < 0.0005)。在基线水平升高的患者中，ALT 的总体降低更为明显。体重从基线时的 144.2 ± 28.0 kg 降至 24 周时的 121.6 ± 25.4 kg (p < 0.0005)，体重指数 (BMI) 从基线时的 50.7 ± 8.1 kg m-2 降至 43.0 ± 7.6 kg m-2 24 周（p < 0.0005）。在接受以牛奶为基础的代餐计划的严重和复杂肥胖的成年人中，最初的 2 周 ALT 出现了意想不到的上升，随后在 24 周内逐渐总体下降。