The impact of phlebotomy in nonalcoholic fatty liver disease: A prospective, randomized, controlled trial

Leon Adams, D.H.G. Crawford, K.A. Stuart, Mike House, Tim St. Pierre, M. Webb, H.L.I. Ching, J. Kava, M. Bynevelt, Gerry Macquillan, George Garas, O.T. Ayonrinde, Trevor Mori, Kevin Croft, Xianwa Niu, Gary Jeffrey, J.K. Olynyk

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Abstract

© 2014 by the American Association for the Study of Liver Diseases. Iron is implicated in the pathogenesis of liver injury and insulin resistance (IR) and thus phlebotomy has been proposed as a treatment for nonalcoholic fatty liver disease (NAFLD). We performed a prospective 6-month randomized, controlled trial examining the impact of phlebotomy on the background of lifestyle advice in patients with NAFLD. Primary endpoints were hepatic steatosis (HS; quantified by magnetic resonance imaging) and liver injury (determined by alanine aminotransaminase [ALT] and cytokeratin-18 [CK-18]). Secondary endpoints included insulin resistance measured by the insulin sensitivity index (ISI) and homeostasis model of assessment (HOMA), and systemic lipid peroxidation determined by plasma F2-isoprostane levels. A total of 74 subjects were randomized (33 phlebotomy and 41 control). The phlebotomy group underwent a median (range) of 7 (1-19) venesection sessions and had a significantly greater reduction in ferritin levels over 6 months, compared to controls (-148±114 vs. -38±89 ng/mL; P
Original languageEnglish
Pages (from-to)1555-1564
JournalHepatology
Volume61
Issue number5
DOIs
Publication statusPublished - 2015

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