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Huang R, Fan JG, Shi JP, Mao YM, Wang BY, Zhao JM, Lu LG, Zhong BH, Zou ZS, Xu YQ, Ye YN, Liu L, Lin LJ, Rao H, Wei L. Stages of psychological change among patients with non-alcoholic fatty liver disease in China: a national cross-sectional study. BMJ Open 2023; 13:e062131. [PMID: 37339833 DOI: 10.1136/bmjopen-2022-062131] [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] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is becoming the leading cause of chronic liver disease worldwide. However, treatment of NAFLD is potentially influenced by psychological conditions. Using the simplified version of the University of Rhode Island Change Assessment (URICA-SV) scale, this study aimed to evaluate the stage of psychological change as a prerequisite to refining implementation strategies for psychological change. DESIGN A multicentre cross-sectional survey. SETTING Ninety hospitals in China. PARTICIPANTS 5181 patients with NAFLD were included in this study. OUTCOME MEASURES All patients completed the URICA-SV questionnaire and were assigned to one of the three stages of change (precontemplation, contemplation or action) according to their readiness scores. A stepwise multivariate logistic regression analysis was used to identify independent factors associated with the stage of psychological change. RESULTS A total of 4832 (93.3%) patients were included in the precontemplation stage and only 349 (6.7%) considered making a change or preparing to make one. There were significant differences in gender (Cohen's d=0.039, p=0.005), age (Cohen's d=-0.327, p<0.001), waist circumference (Cohen's d=0.143, p=0.003), alanine transaminase (Cohen's d=0.347, p=0.001), triglyceride (Cohen's d=0.351, p=0.002), body mass index (BMI; Cohen's d=0.056, p<0.001), proportion of hyperlipidaemia (Cohen's d=0.068, p<0.001) and cardiovascular disease (Cohen's d=0.032, p=0.029), therapeutic regimen (Cohen's d=0.136, p<0.001), and Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease overall score (Cohen's d=-0.420, p<0.001) between patients with NAFLD in the precontemplation stage and those in the contemplation/action stage. Logistic regression identified BMI (HR 0.659, 95% CI 0.469 to 0.928, p=0.017), cardiovascular disease (HR 2.161, 95% CI 1.089 to 4.287, p=0.027) and triglyceride (HR 0.751, 95% CI 0.591 to 0.955, p=0.020) as independent factors predicting psychological change. CONCLUSIONS The results demonstrated that very few patients with NAFLD presented psychological condition in the stage of action. Psychological condition was found to be significantly related to BMI, cardiovascular disease and triglyceride factors. Integrated diversity considerations for evaluating psychological change are necessary.
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Affiliation(s)
- Rui Huang
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Jian-Gao Fan
- Department of Hepatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun-Ping Shi
- Department of Hepatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yi-Min Mao
- Department of Digestive, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing-Yuan Wang
- Department of Digestive, The First Hospital of China Medical University, Shenyang, China
| | - Jing-Min Zhao
- Department of Pathology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Lun Gen Lu
- Department of Hepatology, The First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bi-Hui Zhong
- Department of Digestive, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Zheng-Sheng Zou
- Department of Pathology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - You-Qing Xu
- Department of Digestive, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Nong Ye
- Department of Infectious Disease, The First Hospital of Fushan, Fushan, China
| | - Longgen Liu
- Department of Hepatology, Third People's Hospital of Changzhou, Changzhou, China
| | - Lian-Jie Lin
- Department of Digestive, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huiying Rao
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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Funuyet-Salas J, Martín-Rodríguez A, Pérez-San-Gregorio MÁ, Romero-Gómez M. Influence of Psychological Biomarkers on Therapeutic Adherence by Patients with Non-Alcoholic Fatty Liver Disease: A Moderated Mediation Model. J Clin Med 2021; 10:2208. [PMID: 34065216 PMCID: PMC8161151 DOI: 10.3390/jcm10102208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023] Open
Abstract
Our aim was to analyze whether depressive symptoms mediated the association between physical quality of life (QoL) and adherence to physical activity in patients with non-alcoholic fatty liver disease (NAFLD), as well as the association between social support and adherence to diet. We also examined whether self-efficacy exerted a moderating role in these associations. QoL (SF-12), social support (MSPSS), depressive symptoms (HADS), self-efficacy (GSE), physical activity (IPAQ) and diet (MEDAS) were evaluated in 413 biopsy-proven NAFLD patients. Mediation and moderated mediation models were conducted using the SPSS PROCESS v3.5 macro. Results showed that depressive symptoms mediated the relationship between physical QoL and adherence to physical activity (indirect effect = 6.248, CI = 1.917-10.727), as well as the relationship between social support and adherence to diet (indirect effect = 0.148, CI = 0.035-0.275). Self-efficacy also moderated the indirect effects of QoL and social support on therapeutic adherence through depressive symptoms. Specifically, the higher self-efficacy was, the lower the negative impact on the NAFLD patient's mental health. In conclusion, self-efficacy is defined as a protective factor for therapeutic adherence by NAFLD patients with a psychosocial risk profile. Self-efficacy should, therefore, be a main psychological target in future multidisciplinary NAFLD approaches.
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Affiliation(s)
- Jesús Funuyet-Salas
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Seville, 41018 Seville, Spain; (A.M.-R.); (M.Á.P.-S.-G.)
| | - Agustín Martín-Rodríguez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Seville, 41018 Seville, Spain; (A.M.-R.); (M.Á.P.-S.-G.)
| | - María Ángeles Pérez-San-Gregorio
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Seville, 41018 Seville, Spain; (A.M.-R.); (M.Á.P.-S.-G.)
| | - Manuel Romero-Gómez
- UCM Digestive Diseases and Ciberehd, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, 41013 Seville, Spain;
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Bullón-Vela V, Abete I, Zulet MA, Xu Y, Martínez-González MA, Sayón-Orea C, Ruiz-Canela M, Toledo E, Sánchez VM, Estruch R, Lamuela-Raventós RM, Almanza-Aguilera E, Fitó M, Salas-Salvadó J, Díaz-López A, Tinahones FJ, Tur JA, Romaguera D, Konieczna J, Pintó X, Daimiel L, Rodriguez-Mateos A, Alfredo Martínez J. Urinary Resveratrol Metabolites Output: Differential Associations with Cardiometabolic Markers and Liver Enzymes in House-Dwelling Subjects Featuring Metabolic Syndrome. Molecules 2020; 25:molecules25184340. [PMID: 32971870 PMCID: PMC7570830 DOI: 10.3390/molecules25184340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Metabolic syndrome (MetS) components are strongly associated with increased risk of non-alcoholic fatty liver disease (NAFLD) development. Several studies have supported that resveratrol is associated with anti-inflammatory and antioxidant effects on health status. The main objective of this study was to assess the putative associations between some urinary resveratrol phase II metabolites, cardiometabolic, and liver markers in individuals diagnosed with MetS. In this cross-sectional study, 266 participants from PREDIMED Plus study (PREvención con DIeta MEDiterránea) were divided into tertiles of total urinary resveratrol phase II metabolites (sum of five resveratrol conjugation metabolites). Urinary resveratrol metabolites were analyzed by ultra- performance liquid chromatography coupled to triple quadrupole mass spectrometry (UPLC-Q-q-Q MS), followed by micro-solid phase extraction (µ-SPE) method. Liver function markers were assessed using serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Moreover, lipid profile was measured by triglycerides, very-low-density lipoprotein cholesterol (VLDL-c), and total cholesterol/high-density lipoprotein ratio (total cholesterol/HDL). Linear regression adjusted models showed that participants with higher total urine resveratrol concentrations exhibited improved lipid and liver markers compared to the lowest tertile. For lipid determinations: log triglycerides (βT3= −0.15, 95% CI; −0.28, −0.02, p-trend = 0.030), VLDL-c, (βT3= −4.21, 95% CI; −7.97, −0.46, p-trend = 0.039), total cholesterol/HDL ratio Moreover, (βT3= −0.35, 95% CI; −0.66, −0.03, p-trend = 0.241). For liver enzymes: log AST (βT3= −0.12, 95% CI; −0.22, −0.02, p-trend = 0.011, and log GGT (βT3= −0.24, 95% CI; −0.42, −0.06, p-trend = 0.002). However, there is no difference found on glucose variables between groups. To investigate the risk of elevated serum liver markers, flexible regression models indicated that total urine resveratrol metabolites were associated with a lower risk of higher ALT (169.2 to 1314.3 nmol/g creatinine), AST (599.9 to 893.8 nmol/g creatinine), and GGT levels (169.2 to 893.8 nmol/g creatinine). These results suggested that higher urinary concentrations of some resveratrol metabolites might be associated with better lipid profile and hepatic serum enzymes. Moreover, urinary resveratrol excreted showed a reduced odds ratio for higher liver enzymes, which are linked to NAFLD.
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Affiliation(s)
- Vanessa Bullón-Vela
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain; (V.B.-V.); (M.A.Z.); (J.A.M.)
| | - Itziar Abete
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain; (V.B.-V.); (M.A.Z.); (J.A.M.)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Correspondence: ; Tel.: +34-94-842-5600 (ext. 806357)
| | - Maria Angeles Zulet
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain; (V.B.-V.); (M.A.Z.); (J.A.M.)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
| | - Yifan Xu
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 9NH, UK; (Y.X.); (A.R.-M.)
| | - Miguel A. Martínez-González
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain
| | - Carmen Sayón-Orea
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain
| | - Miguel Ruiz-Canela
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain
| | - Estefanía Toledo
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain
| | - Vicente Martín Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
| | - Ramon Estruch
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
| | - Rosa María Lamuela-Raventós
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Department of Nutrition, Food Sciences and Gastronomy, XaRTA, INSA-UB, School of Pharmacy and Food Sciences, Nutrition and Food Safety Research Institute, University of Barcelona, 08028 Barcelona, Spain
| | - Enrique Almanza-Aguilera
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Research Institute (IMIM), 08007 Barcelona, Spain;
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Nutrition and Food Safety (INSA-UB), University of Barcelona, Santa Coloma de Gramenet, 08921 Barcelona, Spain
| | - Montserrat Fitó
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Research Institute (IMIM), 08007 Barcelona, Spain;
| | - Jordi Salas-Salvadó
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutrició Humana, 43201 Reus, Spain
- Institut d’Investigació Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
| | - Andrés Díaz-López
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutrició Humana, 43201 Reus, Spain
- Institut d’Investigació Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
| | - Francisco J. Tinahones
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Department of Endocrinology, Instituto de Investigación Biomédica de Málaga-IBIMA, University of Málaga, Virgen de la Victoria Hospital, 29010 Málaga, Spain
| | - Josep A. Tur
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Dora Romaguera
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain
| | - Jadwiga Konieczna
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), 07120 Palma de Mallorca, Spain
| | - Xavier Pintó
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Lidia Daimiel
- Precision Nutrition Program, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain;
| | - Ana Rodriguez-Mateos
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 9NH, UK; (Y.X.); (A.R.-M.)
| | - José Alfredo Martínez
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain; (V.B.-V.); (M.A.Z.); (J.A.M.)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.A.M.-G.); (C.S.-O.); (M.R.-C.); (E.T.); (R.E.); (R.M.L.-R.); (M.F.); (J.S.-S.); (A.D.-L.); (F.J.T.); (J.A.T.); (D.R.); (J.K.); (X.P.)
- Precision Nutrition Program, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain;
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