Weight Loss and Change in Alanine Aminotransferase (ALT) Among Patients with Nonalcoholic Fatty Liver Disease (NAFLD) Receiving Standard Care in Real World Clinical Practice: TARGET-NASH.

Challenge

Weight loss is a primary treatment goal in NAFLD, and ALT normalization is often used as a secondary endpoint, but the magnitude of weight loss required to achieve meaningful ALT reduction in real-world NAFLD patients receiving standard care—across disease severity strata—had not been quantified.

Solution

The TARGET-NASH cohort was used to characterize the relationship between weight loss percentage and ALT change across NAFL, NASH, and cirrhosis subgroups in patients receiving usual care, providing empirical benchmarks for weight loss-ALT response in a real-world population.

Impact

Establishing the weight-loss threshold associated with meaningful ALT reduction in real-world NAFLD patients informs the design of lifestyle intervention arms in NAFLD trials and provides real-world benchmarks for interpreting ALT changes in the context of weight loss in drug trials.