[Possibilities of behavior modification in the treatment of diabetes mellitus and obesity]

[Outcome of a one-year behavior therapy weight loss program]

INTRODUCTION

Treatment of obesity has become one of the most challenging issues.

AIM

The aims of the authors were to present the results of standard behavior therapy weight loss program combined with self-help and the results of one-year follow-up.

METHOD

The 24-week program involved 41 participants of which 33 subjects participated in the follow-up. Anthropometric data were obtained and the participants were asked to fill questionnaires (the 21 items Three Factor Eating Questionnair Revised 21 items; Physical Exercise: Steps of change [Short Form].

RESULTS

87.8% of participants achieved a minimum weight loss of 5% which is the rate expected in professional therapies for obesity. Significant changes in maladaptive eating pattern and an increase in the rate of regular exercise were observed. Significant association was found between the increase of cognitive restraint and the rate of weight loss during treatment. At one-year follow-up the majority of participants (75.8%) did keep their minimum weight loss of 5% and they showed significant change in eating pattern.

CONCLUSIONS

The results suggest that standard behavior therapy extended with self-help elements may be a cost-effective treatment of obesity.

[Non-alcoholic fatty liver disease and steatohepatitis]

Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, the hepatic manifestations of metabolic syndrome with close association with inzulin resistance and obesity, are the most common liver diseases, affecting up to a third of the population worldwide. They confer increased risk for hepatocellular carcinoma as well as cardiovascular diseases. The review aims to summarize advances in epidemiology, pathogenesis and clinical management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Besides liver biopsy and biomarkers, a novel non-invasive diagnostic tool the called "controlled attenuation parameter" measuring the attenuation of ultrasound generated by the transient elastography transducer, can quantitatively assess the hepatic fat content and differentiate between steatosis grades. At the same time, liver stiffness (fibrosis) can also be evaluated. The authors present their own results obtained with the latter procedure. In non-alcoholic fatty liver disease, the lifestyle intervention, weight loss, diet and exercise supported by cognitive behavioural therapy represent the basis of management. Components of metabolic syndrome (obesity, dyslipidaemia, diabetes and arterial hypertension) have to be treated. Although there is no approved pharmacological therapy for NASH, it seems that long lasting administration of vitamin E in association with high dose ursodeoxycholic acid may be beneficial. In addition, omega-3 polyunsaturated fatty acid substitution can also decrease liver fat, however, the optimal dose is not known yet. Further controlled clinical studies are warranted to establish the real value of any suggested treatment modalities for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, although these are in experimental phase yet.

Quality of life in diabetes mellitus assessed on the basis of Hungarostudy Health Panel survey

Introduction: Examining the quality of life has a great importance in the treatment of chronic patients. Aim: The aim of the authors was to assess the national status on the basis of the database of the Hungarostudy Health Panel using statistical evaluation. Methods: Three validated questionnaries in the test-battery served as instruments: the shortened version of the WHO Well-being Questionnaire, the Shortened Beck’s Depression Scale Rating and the Illness Intrusiveness Rating Scale. Results: It was found that in accordance with international data, the quality of life index of Hungarian diabetic patients was significantly worse than that of the non-diabetic population. Conclusions: International data also show that the decline in quality of life is correlated with a decline of cooperation and life expectancy of diabetic patients. This explains why methods of behavioral medicine focusing on improving life quality are of great importance, that have not yet been considered currently in psychoeducation. Referring to international examples the authors make a proposal on an extensive survey among Hungarian diabetic patients with the help of validated disease-specific questionnaires and using Transtheoretical Model in order to make education more efficient. Orv. Hetil., 2013, 154, 531–537.