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Özdede M, Güven AT, Eroğlu BÇ. In-depth assessment of steatotic liver disease awareness in high-risk groups. J Eval Clin Pract 2024. [PMID: 38993006 DOI: 10.1111/jep.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES This study aims to determine the awareness levels and factors affecting it, along with prevalent misconceptions about Steatotic Liver Disease (SLD) among participants with high-risk indicators. METHODS A questionnaire with open-ended questions was utilized. Participants were recruited from two general internal medicine outpatient clinics, focusing on those with high-risk indicators for SLD. Data collection involved a questionnaire covering demographic information, self-reported clinical conditions, and open-ended questions about SLD awareness. Key focus areas included misconceptions, thematic awareness, and the relationship between awareness and educational attainment. RESULTS The study involved 228 participants, predominantly female (70.4%), with an average age of 53.8 years. Only 33.7% showed a comprehensive understanding of all aspects of SLD. However, 90.4% provided some accurate information, though often limited or incomplete. Higher education and awareness of SLD risks were key predictors of better understanding. The logistic regression model, with an accuracy of 0.76 and recall of 0.84, found higher education inversely related to low awareness. Common misconceptions highlighted included the belief that polypharmacy or certain medications cause SLD, fatigue as an effect, and increased water intake as a treatment. Notably, seven patients mentioned artichoke consumption as a potential treatment. CONCLUSION The findings highlight the gap between comprehensive and partial awareness of SLD among high-risk individuals. Educational level and informed understanding of SLD risks are crucial for improving awareness, emphasizing the need for specialized educational efforts and risk communication to high-risk patients.
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Affiliation(s)
- Murat Özdede
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
- Center for Genomics and Rare Diseases, Hacettepe University, Ankara, Türkiye
| | - Alper Tuna Güven
- Department of Internal Medicine, Division of General Internal Medicine, Başkent University Faculty of Medicine, Ankara, Türkiye
| | - Burcu Çelik Eroğlu
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Du Y, Ratnapradipa KL, Su D, Dong J, Rochling FA, Farazi PA. Effects of Interventions for Improving Awareness and Knowledge of Nonalcoholic Fatty Liver Disease Among Chinese Young Adults for Prevention of Liver Cancer-A Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:253-263. [PMID: 38430453 DOI: 10.1007/s13187-024-02404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
Chinese young adults (CYA), who are at an increasing risk of developing nonalcoholic fatty liver disease (NAFLD), which in turn increases the risk of liver cancer, are an ideal target population to deliver educational interventions to improve their awareness and knowledge of NAFLD and consequently reduce their risk of developing NAFLD. The purpose of this study was to determine the efficacy of two interventions to improve awareness and knowledge of NAFLD among CYA for the prevention of liver cancer. Between May and July 2021, 1373 undergraduate students aged 18 to 25 years in one university in China completed a web-based, self-administered survey distributed through WeChat app. One week after completion of the baseline survey, all eligible participants were randomly assigned to a pamphlet, a video intervention, or no intervention (control group), with follow-up assessments immediately and 1-month post-intervention. The 7-page pamphlet or 6.5-min video had information on NAFLD. Self-assessments included NAFLD awareness, lean NAFLD awareness, and knowledge scores of NAFLD. About 26% of participants had NAFLD awareness at baseline. Compared with controls, participants in both interventions showed significant improvement of awareness of NAFLD (pamphlet, + 46.0%; video, + 44.3%; control, + 18.7%; OR [95% CI], 3.13 [2.19-4.47] and 2.84 [1.98-4.08]), awareness of lean NAFLD (pamphlet, + 41.2%; video, + 43.0%; control, + 14.5%; OR [95% CI], 2.84 [1.62-4.99] and 2.61 [1.50-4.54]), and knowledge score of NAFLD (pamphlet, + 64.2%; video, + 68.9%; control, - 1.0%; OR [95% CI], 1.62 [1.47-1.80] and 1.67 [1.50-1.86]) at immediately post-intervention. Delivering NAFLD education through a pamphlet or video intervention was effective in improving the awareness and knowledge of NAFLD among CYA.
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Affiliation(s)
- Yi Du
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA
| | - Dejun Su
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Jianghu Dong
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Fedja A Rochling
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198-4395, USA.
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3
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Shea S, Lionis C, Kite C, Lagojda L, Uthman OA, Dallaway A, Atkinson L, Chaggar SS, Randeva HS, Kyrou I. Non-alcoholic fatty liver disease and coexisting depression, anxiety and/or stress in adults: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1357664. [PMID: 38689730 PMCID: PMC11058984 DOI: 10.3389/fendo.2024.1357664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 05/02/2024] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease, affecting 25-30% of the general population globally. The condition is even more prevalent in individuals with obesity and is frequently linked to the metabolic syndrome. Given the known associations between the metabolic syndrome and common mental health issues, it is likely that such a relationship also exists between NAFLD and mental health problems. However, studies in this field remain limited. Accordingly, the aim of this systematic review and meta-analysis was to explore the prevalence of one or more common mental health conditions (i.e., depression, anxiety, and/or stress) in adults with NAFLD. Methods PubMed, EBSCOhost, ProQuest, Ovid, Web of Science, and Scopus were searched in order to identify studies reporting the prevalence of depression, anxiety, and/or stress among adults with NAFLD. A random-effects model was utilized to calculate the pooled prevalence and confidence intervals for depression, anxiety and stress. Results In total, 31 studies were eligible for inclusion, involving 2,126,593 adults with NAFLD. Meta-analyses yielded a pooled prevalence of 26.3% (95% CI: 19.2 to 34) for depression, 37.2% (95% CI: 21.6 to 54.3%) for anxiety, and 51.4% (95% CI: 5.5 to 95.8%) for stress among adults with NAFLD. Conclusion The present findings suggest a high prevalence of mental health morbidity among adults with NAFLD. Given the related public health impact, this finding should prompt further research to investigate such associations and elucidate potential associations between NAFLD and mental health morbidity, exploring potential shared underlying pathophysiologic mechanisms. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021288934.
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Affiliation(s)
- Sue Shea
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Christos Lionis
- Laboratory of “Health and Science” School of Medicine, University of Crete, Heraklion, Greece
- Department of Health, Medicine and Caring Sciences, University of Linkoping, Linkoping, Sweden
- Department of Nursing, Frederick University, Nicosia, Cyprus
| | - Chris Kite
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
- Chester Medical School, University of Chester, Shrewsbury, United Kingdom
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, United Kingdom
| | - Lukasz Lagojda
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Clinical Evidence-Based Information Service (CEBIS), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Olalekan A. Uthman
- Division of Health Sciences, Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Alexander Dallaway
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Lou Atkinson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- iPrescribe Exercise Digital Ltd (EXI), London, United Kingdom
| | | | - Harpal S. Randeva
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, United Kingdom
- Institute of Cardiometabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Ioannis Kyrou
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, United Kingdom
- Institute of Cardiometabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, Athens, Greece
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4
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Tincopa MA, Patel N, Shahab A, Asefa H, Lok AS. Implementation of a randomized mobile-technology lifestyle program in individuals with nonalcoholic fatty liver disease. Sci Rep 2024; 14:7452. [PMID: 38548875 PMCID: PMC10978851 DOI: 10.1038/s41598-024-57722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
Identifying effective, feasible, low-cost interventions that promote sustainable lifestyle changes in nonalcoholic fatty liver disease (NAFLD) is a key unmet need. The aim of this study was to assess predictors of lifestyle practice patterns of NAFLD patients and evaluate the implementation of a mobile technology-based intervention. We prospectively enrolled adults with NAFLD (diagnosed by imaging or biopsy). Individuals with additional liver diseases or decompensated cirrhosis were excluded. Patient were randomized to usual care or a FitBit based program for 6-months. We obtained anthropometrics, labs, vibration controlled transient elastography (VCTE), health-related quality of life (HRQOL), physical activity, diet and motivation to change data. 70 patients were enrolled, 33% with cirrhosis. Median age was 52.1 years, 47% males, 83% white, body mass index 32.3, liver stiffness 7.6 kPa, controlled attenuation parameter 319 db/m, and 50% had diabetes. Baseline HRQOL was 5.4/7 and independently negatively correlated with level of concern about their disease and positively with physical function. Younger age was independently associated with unhealthy diets whereas diabetes was independently associated with unhealthy diets and higher VCTE kPa. 6-month follow-up data available on 31 patients showed trends in improvement in weight. In a cohort of NAFLD patients, we identified independent correlates of lifestyle behaviors and HRQOL. Implementation of interventions that improve physical function may improve HRQOL in NAFLD. Younger patients and those with diabetes appeared to have the greatest need for dietary interventions. Structured mobile technology lifestyle interventions using Fitbit and personalized coaching showed promise but require further validation with a focus on sustainability of intervention and improvement in outcomes.
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Affiliation(s)
- Monica A Tincopa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California San Diego, 9350 Campus Point Dr Ste 2B #0975, San Diego, CA, USA.
| | - Nik Patel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Areesha Shahab
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Haila Asefa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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5
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Cusi K, Budd J, Johnson E, Shubrook J. Making Sense of the Nonalcoholic Fatty Liver Disease Clinical Practice Guidelines: What Clinicians Need to Know. Diabetes Spectr 2024; 37:29-38. [PMID: 38385100 PMCID: PMC10877212 DOI: 10.2337/dsi23-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Standards of care summarized in clinical practice guidelines for nonalcoholic fatty liver disease (NAFLD) offer clinicians a streamlined diagnostic and management approach based on the best available evidence. These recommendations have changed a great deal in recent years; today, there is a clear focus on screening for the early identification and risk stratification of patients at high risk of steatohepatitis and clinically significant fibrosis to promote timely referrals to specialty care when needed. This article reviews and provides the rationale for current guidelines for NAFLD screening, diagnosis, treatment, and monitoring and addresses barriers to providing evidence-based NAFLD care and how to overcome them. The current paradigm of care calls for primary care clinicians and specialists to work together, within a multidisciplinary care team familiar with obesity and diabetes care, to provide comprehensive management of these complex patients.
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Affiliation(s)
- Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Jeff Budd
- Division of General Internal Medicine, University of Florida, Gainesville, FL
| | - Eric Johnson
- Department of Family and Community Medicine, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND
| | - Jay Shubrook
- Department of Clinical Sciences and Community Health, Touro University California College of Osteopathic Medicine, Vallejo, CA
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6
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Miwa T, Tajirika S, Hanai T, Imamura N, Adachi M, Horita R, Fukao T, Shimizu M, Yamamoto M. Usefulness of a questionnaire for assessing the relationship between eating behavior and steatotic liver disease among Japanese male young adults. Sci Rep 2024; 14:2194. [PMID: 38273030 PMCID: PMC10810865 DOI: 10.1038/s41598-024-52797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
This study aimed to reveal the relationship between eating behavior and nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) in young adults and suggest a questionnaire for eating behavior assessment. We included 322 male graduate students at Gifu University. Diagnoses of NAFLD and MASLD were based on the presence of hepatic steatosis on ultrasonography. Eating behavior was assessed using the eating behavior questionnaire (EBQ) recommended by the Japan Society for the Study of Obesity. We assessed the eating behaviors associated with NAFLD and MASLD using logistic regression, decision tree, and random forest analyses. The median age of the participants was 22 years, and 16% and 11% had NAFLD and MASLD, respectively. The EBQ total score was significantly higher in participants with MASLD than in those without MASLD (102 vs. 90 points, P = 0.006) and in those with NAFLD than in those without NAFLD (97 vs. 90 points, P = 0.007). Among eating behavior categories, the decision tree and random forest analyses revealed that "perception of constitution and weight" was the strongest contributor for NAFLD/MASLD. Our study revealed that eating behavior assessed with the EBQ is robustly associated with NAFLD and MASLD in young male adults.
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Affiliation(s)
- Takao Miwa
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan.
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan.
- Gifu University Hospital, Gifu, Japan.
| | - Satoko Tajirika
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
- Gifu University Hospital, Gifu, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
- Gifu University Hospital, Gifu, Japan
| | - Nanako Imamura
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Miho Adachi
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
- Gifu University Hospital, Gifu, Japan
| | - Ryo Horita
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
- Gifu University Hospital, Gifu, Japan
| | - Taku Fukao
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
- Gifu University Hospital, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
- Gifu University Hospital, Gifu, Japan
| | - Mayumi Yamamoto
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
- Gifu University Hospital, Gifu, Japan
- United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan
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Verma M, Desai AP. The role of patient-reported outcomes in a patient-centered care model for managing chronic liver diseases. Clin Liver Dis (Hoboken) 2024; 23:e0222. [PMID: 38881726 PMCID: PMC11177829 DOI: 10.1097/cld.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/15/2024] [Indexed: 06/18/2024] Open
Affiliation(s)
- Manisha Verma
- Department of Medicine, Jefferson Einstein Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Archita P Desai
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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8
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Romero-Gómez M, Zelber-Sagi S, Martín F, Bugianesi E, Soria B. Nutrition could prevent or promote non-alcoholic fatty liver disease: an opportunity for intervention. BMJ 2023; 383:e075179. [PMID: 37813416 PMCID: PMC10561058 DOI: 10.1136/bmj-2023-075179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Manuel Romero-Gómez
- UCM Digestive Diseases and Ciberehd. Virgen del Rocío University Hospital, Spain
- Institute of Biomedicine of Seville (HUVR/CSIC/US), Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa, Israel
- Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Franz Martín
- Andalusian Center of Molecular Biology and Regenerative Medicine (CABIMER), Pablo de Olavide University, University of Seville, Spain
- Biomedical Research Network on Diabetes and Related Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabetta Bugianesi
- Department of Medical Sciences, University of Turin, Turin, Italy
- Division of Gastroenterology, Città Della Salute e Della Scienza University-Hospital, Turin, Italy
| | - Bernat Soria
- Unit of Advanced Therapies and Regenerative Medicine, Health Research Institute of the Dr Balmis University Hospital of Alicante (ISABIAL), Institute of Bioengineering University Miguel Hernández, CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
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9
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Lee JH, Jung JH, Park H, Oh JH, Ahn SB, Yoon EL, Jun DW. A survey on the awareness, current management, and barriers for non-alcoholic fatty liver disease among the general Korean population. Sci Rep 2023; 13:15205. [PMID: 37709931 PMCID: PMC10502016 DOI: 10.1038/s41598-023-42176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is often diagnosed incidentally during medical evaluation for diseases other than liver disease or during health checkups. This study aimed to investigate the awareness, current status, and barriers to the management of NAFLD in the general population. This cross-sectional study used an online survey, which consisted of 3-domain and 18-item questionnaires. The content validity index for each item of the questionnaire was rated above 0.80. Most respondents (72.8%) reported having heard of the term 'NAFLD', and a large proportion of the general population (85.7%) recognized the possibility of developing fatty liver without consuming alcohol. Awareness of the terminology of NAFLD and that NAFLD is a disease that needs to be managed is relatively high. However, the knowledge that NAFLD can progress to end-stage liver disease and new cardiovascular diseases is lacking. Only 25.7% of the general population is aware that NAFLD increases the incidence of heart and cerebrovascular diseases. Only 44.7% of those who were incidentally diagnosed during a health check-up were provided with any specific guidance on NAFLD, and more than half (55.3%) were not provided with education or guidance on NAFLD or did not remember it. Only 40.2% of people diagnosed with NAFLD incidentally visited a clinic. The reason for not visiting a clinic for the evaluation of NAFLD varied greatly depending on sex and age group. Only 40.2% of patients visited the clinic after being diagnosed with NAFLD. The reasons for not visiting the clinic after NAFLD diagnosis differed significantly according to sex and age.
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Affiliation(s)
- Jun-Hyuk Lee
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University, College of Medicine, Daejeon, Republic of Korea
- Department of Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Jang Han Jung
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University, College of Medicine, Chuncheon, Republic of Korea
| | - Huiyul Park
- Department of Family Medicine, Myongji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joo Hyun Oh
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, College of Medicine, Daejeon, Republic of Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, College of Medicine, Daejeon, Republic of Korea
| | - Eileen Laurel Yoon
- Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-ru, Seoul, 04763, Republic of Korea.
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Republic of Korea.
- Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-ru, Seoul, 133-791, Republic of Korea.
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-ru, Seoul, 04763, Republic of Korea.
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Republic of Korea.
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10
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Balakrishnan M, Liu K, Schmitt S, Heredia NI, Sisson A, Montealegre JR, Hernaez R, Kanwal F, Foreyt J. Behavioral weight-loss interventions for patients with NAFLD: A systematic scoping review. Hepatol Commun 2023; 7:e0224. [PMID: 37534947 PMCID: PMC10553168 DOI: 10.1097/hc9.0000000000000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/12/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Clinically significant weight loss-which requires sustained dietary and physical activity changes-is central to treating NAFLD. Although behavioral interventions have demonstrated effectiveness in promoting weight loss among primary prevention populations, the data are limited among patients with NAFLD who need weight loss for treatment. We undertook this scoping review to map the existing data on the characteristics, weight-loss outcomes, and determinants of success of interventions evaluated among patients with NAFLD. METHODS We searched Medline, EMBASE, Cochrane, PsycINFO, and Web of Science from inception to January 1, 2023 to identify publications reporting weight loss among adults with NAFLD in behavioral weight-loss interventions. We summarized interventions and classified them as successful if there was an average weight loss of ≥ 5% from baseline across enrolled participants or achieved by ≥ 50% of enrolled participants. RESULTS We included 28 studies: 10 randomized control trials, ten quasi-experimental, and 8 observational studies. Intervention delivery, duration, and counseling frequency varied; 12 were successful. Retention was highest among telephone interventions and lowest among "real-world" face-to-face interventions. Patients who were women, younger, and/or had multiple metabolic conditions were most likely to dropout. Successful interventions had biweekly counseling, specific physical activity, and calorie targets, behavioral theory grounding, and promoted goal-setting, self-monitoring, and problem-solving. CONCLUSION There are limited data on behavioral weight-loss interventions in NAFLD. Research is needed to develop effective interventions generalizable to diverse patient populations and that maximize adherence, particularly among patients who are diabetic, women, and younger.
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Affiliation(s)
- Maya Balakrishnan
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kyle Liu
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sydney Schmitt
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Natalia I. Heredia
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Amy Sisson
- Houston Academy of Medicine Texas Medical Center Library, Houston, Texas, USA
| | | | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - John Foreyt
- Division of General Internal Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
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Policarpo SRO, Machado MV, Barreira D, Cortez-Pinto H. NAFLD Nutritional Management: Results from a Multidisciplinary Approach. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:401-408. [PMID: 36545180 PMCID: PMC9761363 DOI: 10.1159/000519932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
Introduction Lifestyle changes are the mainstay treatment of nonalcoholic fatty liver disease (NAFLD). We aimed to assess the magnitude of weight loss in a group of NAFLD patients followed on a combined lifestyle intervention by a multidisciplinary team. Methods Patients were assessed before and after a 12-month dietary intervention (Mediterranean diet aiming at weight loss). Patients who received a structured dietary plan along with general lifestyle recommendations were designated as the multidisciplinary treatment (MdT) group. Patients who declined follow-up still received general lifestyle recommendations and were designated as the conventional treatment group, being used as a control group. Results From the 77 patients with documented NAFLD, 31.2% of patients were overweight and 55.8% obese; 66 patients constituted the MdT group and 11 the conventional treatment group. After 3 months, 89% of patients lost weight; at 6 months, 75.4% maintained the weight lost. At 12 months, 65% of patients still decreased their weight, with 92.2% of patients in the MdT group still maintaining a lower weight than baseline versus just 50% in the conventional group (p = 0.008). Only patients in the MdT group presented a weight loss higher than 10% (9.6%; n = 6). At 12 months patients in the MdT group presented an average reduction of 4.2 kg versus a reduction of just 0.6 kg in the conventional treatment group (p = 0.016). The MdT group, but not the conventional group, presented significant differences in liver enzymes at 12 months compared to baseline. Conclusion Adherence to a multidisciplinary approach, compared to management solely by a hepatologist, in NAFLD patients, is effective with greater weight loss after a 12-month follow-up and a lower rate of weight gain recurrence.
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Affiliation(s)
- Sara Raquel Osório Policarpo
- Serviço de Dietética e Nutrição, CHULN − Hospital Santa Maria, Lisboa, Portugal,Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal,*Sara Raquel Osório Policarpo,
| | - Mariana V. Machado
- Departamento de Gastrenterologia, CHULN − Hospital de Santa Maria, Lisboa, Portugal,Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - David Barreira
- Departamento de Gastrenterologia, CHULN − Hospital de Santa Maria, Lisboa, Portugal
| | - Helena Cortez-Pinto
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal,Departamento de Gastrenterologia, CHULN − Hospital de Santa Maria, Lisboa, Portugal,Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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