1
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Stine JG, Hummer B, Smith N, Tressler H, Heinle JW, VanKirk K, Harris S, Moeller M, Luzier G, DiJoseph K, Hussaini Z, Jackson R, Rodgers B, Schreibman I, Stonesifer E, Tondt J, Sica C, Nighot P, Chinchilli VM, Loomba R, Sciamanna C, Schmitz KH, Kimball SR. AMPED study: Protocol for a randomized controlled trial of different doses of aerobic exercise training. Hepatol Commun 2024; 8:e0464. [PMID: 38896071 PMCID: PMC11186820 DOI: 10.1097/hc9.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 06/21/2024] Open
Abstract
Recently renamed, metabolic dysfunction-associated steatotic liver disease remains a leading cause of chronic liver disease worldwide. Regular physical activity is recommended as a treatment for all with this condition because it is highly efficacious, especially when exercise training is undertaken with a specific goal in mind. Despite decades of research demonstrating exercise's efficacy, key questions remain about the mechanism of benefit and most efficacious dose, as well as the independent impact on liver histology. To answer these questions, we present the design of a 16-week randomized controlled clinical trial of 45 adults aged 18-69 years with metabolic dysfunction-associated steatohepatitis. The primary aim of this study is to better understand the dose required and mechanisms to explain how exercise impacts multiple clinical end points in metabolic dysfunction-associated steatohepatitis. The primary outcome is MRI-measured liver fat. Secondary outcomes include other biomarkers of liver fibroinflammation, liver histology, and mechanistic pathways, as well as cardiometabolic risk and quality of life. This is the first study to compare different doses of exercise training to determine if there is a differential impact on imaging and serum biomarkers as well as liver histology.
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Affiliation(s)
- Jonathan G. Stine
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Division of Gastroenterology & Hepatology, Department of Mediicne, Fatty Liver Program, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Liver Center, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, The Pennsylvania State University—College of Medicine, Hershey, Pennsylvania, USA
- Cancer Institute, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Breianna Hummer
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Nataliya Smith
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Heather Tressler
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - J. Westley Heinle
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kyra VanKirk
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Sara Harris
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Matthew Moeller
- Department of Medicine, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Gavin Luzier
- Department of Medicine, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kara DiJoseph
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Zeba Hussaini
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ryan Jackson
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Brandon Rodgers
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ian Schreibman
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Liver Center, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Elizabeth Stonesifer
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Division of Gastroenterology & Hepatology, Department of Mediicne, Fatty Liver Program, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Liver Center, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Justin Tondt
- Division of Gastroenterology & Hepatology, Department of Mediicne, Fatty Liver Program, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Family Medicine, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Chris Sica
- College of Medicine, Center for NMR Research, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Prashant Nighot
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University—College of Medicine, Hershey, Pennsylvania, USA
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, San Diego, California, USA
- NAFLD Research Center, University of California San Diego, San Diego, California, USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University—College of Medicine, Hershey, Pennsylvania, USA
- Department of Medicine, Penn State Health—Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kathryn H. Schmitz
- Division of Hematology & Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Scot R. Kimball
- Department of Physiology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Freer CL, George ES, Tan SY, Abbott G, Daly RM. Delivery of a telehealth supported home exercise program with dietary advice to increase plant-based protein intake in people with non-alcoholic fatty liver disease: a 12-week randomised controlled feasibility trial. Br J Nutr 2024; 131:1709-1719. [PMID: 38268105 PMCID: PMC11063658 DOI: 10.1017/s0007114524000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
This study evaluated the feasibility and safety of a telehealth delivered exercise plus plant-based protein diet in adults with non-alcoholic fatty liver disease (NAFLD). This was a 12-week, randomised controlled feasibility trial including twenty-eight adults aged > 45 years with NAFLD randomised to a home muscle strengthening program (3 d/week) with increased protein intake (target ∼1·2-1·5 g/kg/d) from predominately plant-based sources and behavioural change support (3-4 text messages/week) (Pro-Ex n 14) or usual care (UC, n 14). Feasibility was assessed via retention (≤ 10 % attrition), adherence (exercise ≥ 66 %; recommended daily protein serves ≥ 80 %) and safety (adverse events). Secondary outcomes included macronutrient intake (3 × 24-h records), weight, moderate-to-vigorous physical activity (MVPA) and 30 s sit-to-stand (STS) performance. Study retention was 89 %. Mean exercise adherence (Pro-Ex) was 52 % with one adverse event from 241 sessions. In Pro-Ex, mean daily plant protein serves increased (0·9 to 1·4/d) and animal protein decreased (1·5 to 1·2/d) after 12-weeks, but overall adherence (serves/day) was 32[RD1] % (plant) and 42 % (animal). Relative to UC, Pro-Ex experienced a mean 2·7 (95 % CI: 0·9, 4·4) increase in 30 s STS number, 46-minute (95 % CI: -153, 245) increase in MVPA, 1·7 kg (95 % CI: -3·5, 0·2) decrease in weight, 35·2 g (95 % CI: 11·0, 59·3) increase in protein. In adults with NAFLD a telehealth home exercise and dietary intervention was safe and improved habitual plant and animal protein intake, but overall adherence was modest suggesting more intensive healthcare support may be required.
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Affiliation(s)
- Christine L. Freer
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Elena S. George
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Sze-Yen Tan
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Robin M. Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) in the United States is 38%, having increased by 50% within the past 3 decades. The estimated NAFLD prevalence among people with type 2 diabetes is 55-70%. The presence of type 2 diabetes is associated with a higher likelihood of progression of NAFLD to fibrosis development, liver transplant, and death. Cardiovascular disease is the main cause of mortality among people with NAFLD, and the risk of death is significantly higher in people with both NAFLD and type 2 diabetes. NAFLD carries high patient and economic burdens but low awareness among both the general public and health care providers. This article reviews the epidemiology of NAFLD and discusses the need for appropriate risk stratification, referral for specialty care, management of cardiometabolic risk factors, and treatment of the disease. The authors present a call to action to raise awareness of NAFLD and address its increasing burden in a systematic and efficient manner.
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Affiliation(s)
- Zobair M. Younossi
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA; The Global NASH Council, Washington, DC, and the Center for Outcomes Research in Liver Diseases, Washington, DC
| | - Linda Henry
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA; The Global NASH Council, Washington, DC, and the Center for Outcomes Research in Liver Diseases, Washington, DC
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Keating SE, Croci I, Wallen MP, Cox ER, Coombes JS, Burton NW, Macdonald GA, Hickman IJ. High-intensity Interval Training for the Management of Nonalcoholic Steatohepatitis: Participant Experiences and Perspectives. J Clin Transl Hepatol 2023; 11:1050-1060. [PMID: 37577222 PMCID: PMC10412696 DOI: 10.14218/jcth.2022.00091s] [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: 11/04/2022] [Revised: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 07/03/2023] Open
Abstract
Background and Aims High-intensity interval training (HIIT) is a therapeutic option for people with nonalcoholic steatohepatitis (NASH). However, the perspectives and experiences of HIIT for people with NASH are unknown, limiting translation of research. We explored the experiences and perspectives of both professionally supervised and self-directed HIIT in people with NASH and evaluated participant-reported knowledge, barriers, and enablers to commencing and sustaining HIIT. Methods Twelve participants with NASH underwent 12 weeks of supervised HIIT (3 days/week, 4×4 minutes at 85-95% maximal heart rate, interspersed with 3 minutes active recovery), followed by 12-weeks of self-directed (unsupervised) HIIT. One-on-one, semistructured participant interviews were conducted by exercise staff prior to HIIT and following both supervised and self-directed HIIT to explore prior knowledge, barriers, enablers, and outcomes at each stage. Interviews were audio-recorded, transcribed, coded, and thematically analyzed by two independent researchers. Results Four dominant themes were identified: (1) no awareness of/experience with HIIT and ambivalence about exercise capabilities; (2) multiple medical and social barriers to commencing and continuing HIIT; (3) exercise specialist support was a highly valued enabler, and (4) HIIT was enjoyed and provided holistic benefits. Conclusions People with NASH may lack knowledge of and confidence for HIIT, and experience multiple complex barriers to commencing and continuing HIIT. Exercise specialist support is a key enabler to sustained engagement. These factors need to be addressed in future clinical programs to augment the uptake and long-term sustainability of HIIT by people with NASH so they can experience the range of related benefits.
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Affiliation(s)
- Shelley E. Keating
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Ilaria Croci
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- K.G. Jebsen Center of Exercise in Medicine Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Faculty of Medicine, Trondheim, Norway
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Matthew P. Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Institute of Health and Wellbeing, Federation University, Mount Helen, Australia
| | - Emily R. Cox
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah, Australia
| | - Jeff S. Coombes
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Nicola W. Burton
- School of Applied Psychology, Griffith University, Mt Gravatt, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Centre for Mental Health, Griffith University, Brisbane, Australia
| | - Graeme A. Macdonald
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ingrid J. Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
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Stine JG, Long MT, Corey KE, Sallis RE, Allen AM, Armstrong MJ, Conroy DE, Cuthbertson DJ, Duarte-Rojo A, Hallsworth K, Hickman IJ, Kappus MR, Keating SE, Pugh CJA, Rotman Y, Simon TL, Vilar-Gomez E, Wai-Sun Wong V, Schmitz KH. Physical Activity and Nonalcoholic Fatty Liver Disease: A Roundtable Statement from the American College of Sports Medicine. Med Sci Sports Exerc 2023; 55:1717-1726. [PMID: 37126039 PMCID: PMC10524517 DOI: 10.1249/mss.0000000000003199] [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] [Indexed: 05/02/2023]
Abstract
ABSTRACT Although physical activity (PA) is crucial in the prevention and clinical management of nonalcoholic fatty liver disease, most individuals with this chronic disease are inactive and do not achieve recommended amounts of PA. There is a robust and consistent body of evidence highlighting the benefit of participating in regular PA, including a reduction in liver fat and improvement in body composition, cardiorespiratory fitness, vascular biology, and health-related quality of life. Importantly, the benefits of regular PA can be seen without clinically significant weight loss. At least 150 min of moderate or 75 min of vigorous intensity PA are recommended weekly for all patients with nonalcoholic fatty liver disease, including those with compensated cirrhosis. If a formal exercise training program is prescribed, aerobic exercise with the addition of resistance training is preferred. In this roundtable document, the benefits of PA are discussed, along with recommendations for 1) PA assessment and screening; 2) how best to advise, counsel, and prescribe regular PA; and 3) when to refer to an exercise specialist.
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Affiliation(s)
- Jonathan G. Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey PA
- Department of Public Health Sciences, The Pennsylvania State University- College of Medicine, Hershey PA
| | - Michelle T. Long
- Section of Gastroenterology, Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Kathleen E. Corey
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Robert E. Sallis
- Department of Family Medicine and Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Matthew J. Armstrong
- Liver Transplant Unit, Queen Elizabeth University Hospitals Birmingham, and NIHR Birmingham Biomedical Research Centre, Birmingham, UNITED KINGDOM
| | - David E. Conroy
- Department of Kinesiology, The Pennsylvania State University, University Park, PA
| | - Daniel J. Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Kate Hallsworth
- Newcastle NIHR Biomedical Research Centre and the Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UNITED KINGDOM
| | - Ingrid J. Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, AUSTRALIA
| | - Matthew R. Kappus
- Division of Gastroenterology and Hepatology, Duke University, Durham, NC
| | - Shelley E. Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, AUSTRALIA
| | - Christopher J. A. Pugh
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UNITED KINGDOM
| | - Yaron Rotman
- Liver & Energy Metabolism Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Tracey L. Simon
- Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Eduardo Vilar-Gomez
- Division of Gastroenterology and Hepatology. Indiana University School of Medicine. Indianapolis
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, CHINA
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Capuano P, Hileman B, Tigano S, Magro B, Lo Re V, Liotta R, Sciveres M, Ranucci G, Provenzani A, Burgio G, Scardulla C, Arcadipane A, Martucci G. Telemedicine in Patients Affected by Chronic Liver Disease: A Scoping Review of Clinical Outcomes and the Devices Evaluated. J Clin Med 2023; 12:5128. [PMID: 37568531 PMCID: PMC10420001 DOI: 10.3390/jcm12155128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
For patients with chronic liver disease (CLD), telemedicine is emerging as a useful tool to prevent liver decompensation or hospitalization, allowing access to and the decentralization of care, even for patients with limited resources. However, research and attendant evidence are still lacking; thus, this review aims to systematically explore the topic of telemonitoring for CLD to describe the currently used tools and clinical outcomes. The review was conducted by using key terms on PubMed/EMBASE and searching for observational studies or clinical trials (according to PRISMA recommendations) that were published between 6 April 2013 and 6 April 2023 to keep the technological framework limited to the last 10 years. The studies were described and grouped according to the aim of telemonitoring, the underlying disease, and the tools adopted to achieve remote monitoring. A total of 32 articles met the inclusion criteria. Of these, 11 articles report the successful use of a telehealth program to support and improve access to care in the management of HCV-related cirrhosis, eight articles examine the efficacy of telemedicine for remote monitoring interventions to prevent or decrease the risk of decompensation in high-risk patients, and five articles examine improvements in the physical performance and quality of life of cirrhotic patients through telehealth rehabilitation programs. Four studies were completed during the recent COVID-19 pandemic. Telehealth has the potential to provide and expand treatment access and reduce barriers to care for the most disadvantaged patients and might be able to reduce the need for hospital readmission for CLD, though most practice to test feasibility is still in the pilot stage.
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Affiliation(s)
- Paolo Capuano
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy; (P.C.); (G.B.); (A.A.)
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
| | - Bethany Hileman
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Stefano Tigano
- Department of Anesthesia and Intensive Care, A.O.U. Policlinico-San Marco, 95123 Catania, Italy;
| | - Bianca Magro
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
| | - Vincenzina Lo Re
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
| | - Rosa Liotta
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
- Pathology Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
| | - Marco Sciveres
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
- Pediatric Center, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
| | - Giusy Ranucci
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
- Pediatric Center, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
| | - Alessio Provenzani
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
- Pharmacy Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
| | - Gaetano Burgio
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy; (P.C.); (G.B.); (A.A.)
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
| | - Cesare Scardulla
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy; (P.C.); (G.B.); (A.A.)
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy; (P.C.); (G.B.); (A.A.)
- University of Pittsburgh Medical Center (UPMC), 90133 Palermo, Italy; (B.M.); (V.L.R.); (R.L.); (M.S.); (G.R.); (A.P.); (C.S.)
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7
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Guarino M, Cossiga V, Cutolo FM, Attanasio MR, Lieto R, Morisco F. COVID-19 and Fatty Liver Disorders. J Clin Med 2023; 12:4316. [PMID: 37445349 DOI: 10.3390/jcm12134316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
In late 2019, the world was shaken by the COVID-19 pandemic. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection became one of the main causes of illness and hospitalization worldwide, especially in subjects with metabolic comorbidities such as obesity, diabetes, or liver disease. This scenario crosses with the metabolic liver disorders' "pandemic", caused by the exponential spreading of non-alcoholic fatty liver disease, which is now the most prevalent cause of chronic liver disease (CLD). The aim of this review is to analyze the key factors of the relationship between COVID-19 and the spectrum of fatty liver disorders (FLD), in terms of molecular mechanisms and clinical presentation which can predict a more severe course of the infection. In addition, this review will face the change in management of FLD during pandemics, with a central role of telemedicine, and the role of other interventions in preventing and treating severe infection in these subjects.
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Affiliation(s)
- Maria Guarino
- Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Valentina Cossiga
- Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Francesco Maria Cutolo
- Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Maria Rosaria Attanasio
- Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Raffaele Lieto
- Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Filomena Morisco
- Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
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8
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Stine JG, Rivas G, Hummer B, Duarte-Rojo A, May CN, Geyer N, Chinchilli VM, Conroy DE, Mitchell ES, McCallum M, Michealides A, Schmitz KH. Mobile health lifestyle intervention program leads to clinically significant loss of body weight in patients with NASH. Hepatol Commun 2023; 7:02009842-202304010-00005. [PMID: 36930864 PMCID: PMC10027041 DOI: 10.1097/hc9.0000000000000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/09/2022] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND AIMS Lifestyle intervention remains the foundation of clinical care for patients with NASH; however, most patients are unsuccessful in enacting sustained behavioral change. There remains a clear unmet need to develop lifestyle intervention programs to support weight loss. Mobile health (mHealth) programs offer promise to address this need, yet their efficacy remains unexplored. APPROACH RESULTS We conducted a 16-week randomized controlled clinical trial involving adults with NASH. Patients were randomly assigned (1:1 ratio) to receive Noom Weight (NW), a mHealth lifestyle intervention program, or standard clinical care. The primary end point was a change in body weight. Secondary end points included feasibility (weekly app engagement), acceptability (>50% approached enrolled), and safety. Of 51 patients approached, 40 (78%) were randomly assigned (20 NW and 20 standard clinical care). NW significantly decreased body weight when compared to standard clinical care (-5.5 kg vs. -0.3 kg, p = 0.008; -5.4% vs. -0.4%, p = 0.004). More NW subjects achieved a clinically significant weight loss of ≥5% body weight (45% vs. 15%, p = 0.038). No adverse events occurred, and the majority (70%) of subjects in the NW arm met the feasibility criteria. CONCLUSIONS This clinical trial demonstrated that NW is not only feasible, acceptable, and safe but also highly efficacious because this mHealth lifestyle intervention program led to significantly greater body weight loss than standard clinical care. Future large-scale studies are required to validate these findings with more representative samples and to determine if mHealth lifestyle intervention programs can lead to sustained, long-term weight loss in patients with NASH.
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Affiliation(s)
- Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Liver Center, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania USA
- Cancer Institute, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Gloriany Rivas
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Breianna Hummer
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christine N May
- Department of Kinesiology, The Pennsylvania State University-State College Pennsylvania, USA
| | - Nathaniel Geyer
- Department of Public Health Sciences, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Ellen Siobhan Mitchell
- Department of Kinesiology, The Pennsylvania State University-State College Pennsylvania, USA
| | - Meaghan McCallum
- Department of Kinesiology, The Pennsylvania State University-State College Pennsylvania, USA
| | - Andreas Michealides
- Department of Kinesiology, The Pennsylvania State University-State College Pennsylvania, USA
| | - Kathryn H Schmitz
- Cancer Institute, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Academic Research, Noom Inc, New York, New York, USA
- Department of Physical Medicine & Rehabilitation, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey Pennsylvania, USA
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Rosenlund M, Kinnunen UM, Saranto K. The Use of Digital Health Services Among Patients and Citizens Living at Home: Scoping Review. J Med Internet Res 2023; 25:e44711. [PMID: 36972122 PMCID: PMC10131924 DOI: 10.2196/44711] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The development of digital health services reflects not only the technical development of services but also a change in attitude and the way of thinking. It has become a cornerstone for engaging and activating patients and citizens in health management while living at home. Digital health services are also aimed at enhancing the efficiency and quality of services, while simultaneously providing services more cost-effectively. In 2020, the COVID-19 pandemic accelerated worldwide the development and use of digital services in response to requirements for social distancing and other regulations. OBJECTIVE The aim of this review is to identify and summarize how digital health services are being used among patients and citizens while living at home. METHODS The Joanna Briggs Institute (JBI) methodology for scoping reviews was used as guidance. A search conducted in 3 databases (CINAHL, PubMed, Scopus) resulted in 419 papers. The reporting was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR), and the analysis of the included papers was performed using a framework consisting of 5 clusters describing the use of digital health services. After screening and excluding papers that did not match the inclusion criteria, 88 (21%) papers from 2010 to 2022 were included in the final analysis. RESULTS Results indicated that digital health services are used in different situations and among different kinds of populations. In most studies, digital health services were used in the form of video visits or consultations. The telephone was also used regularly for consultations. Other services, such as remote monitoring and transmitting of recorded information and the use the of internet or portals for searching information, were observed as well. Alerts, emergency systems, and reminders were observed to offer possibilities of use, for example, among older people. The digital health services also showed to have potential for use in patient education. CONCLUSIONS The development of digital services reflects a shift toward the provision of care regardless of time and place. It also reflects a shift toward emphasis on patient-centered care, meaning activating and engaging patients in their own care as they use digital services for various health-related purposes. Despite the development of digital services, many challenges (eg, adequate infrastructure) still prevail worldwide.
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Affiliation(s)
- Milla Rosenlund
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Ulla-Mari Kinnunen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| | - Kaija Saranto
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
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10
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Versteegden D, van Himbeeck M, Burghoorn AW, Lovei P, Deckers E, Jansen JM, Nienhuijs S. The Value of Tracking Data on the Behavior of Patients Who Have Undergone Bariatric Surgery: Explorative Study. JMIR Form Res 2022; 6:e27389. [PMID: 35522477 PMCID: PMC9123534 DOI: 10.2196/27389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/23/2021] [Accepted: 03/29/2022] [Indexed: 12/13/2022] Open
Abstract
Background To maintain the benefits of a bariatric procedure, patients have to change their lifestyle permanently. This happens within a context of coresponsibilities of health care professionals and their social support system. However, most interventions are focused on the patient as an individual. In this explorative pilot study, behavioral, contextual, and experiential data were gathered to obtain insight on coresponsibility. Objective The aim of this study is to explore the use of trackers by patients who have undergone bariatric surgery in a data-enabled design approach. Methods Behavioral and contextual data on the households of patients who have undergone bariatric surgery were explored using a smartphone with an interactive user interface (UI), weight scale, activity bracelet, smart socket, accelerometer motion sensor, and event button to find examples of opportunities for future interventions. Results A total of 6 households were monitored. Approximately 483,000 data points were collected, and the participants engaged in 1483 conversations with the system. Examples were found using different combinations of data types, which provided the obesity team a better understanding of patient behaviors and their support system, such as a referral to a family coach instead of a dietician. Another finding regarding the partners was, for example, that the conversational UI system facilitated discussion about the support structure by asking for awareness. Conclusions An intelligent system using a combination of quantitative data gathered by data tracking products in the home environment and qualitative data gathered by app-enhanced short conversations, as well as face-to-face interviews, is useful for an improved understanding of coresponsibilities in the households of patients who have undergone bariatric surgery. The examples found in this explorative study so far encourage research in this field.
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Affiliation(s)
- Dirk Versteegden
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | | | | | - Peter Lovei
- Philips Experience Design, Eindhoven, Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Eva Deckers
- Philips Experience Design, Eindhoven, Netherlands
| | | | - Simon Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
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11
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Moein H, Arteaga EJ, Sarkar S. Using Telehealth for Diagnosis and Management of Non-Alcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken) 2022; 19:171-175. [PMID: 35505922 PMCID: PMC9053681 DOI: 10.1002/cld.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/03/2021] [Accepted: 11/13/2021] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Interview and Author Audio Recording.
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Affiliation(s)
- Hamid‐Reza Moein
- Division of Gastroenterology and HepatologyCarolinas Medical CenterAtrium Health Wake Forest BaptistCharlotteNC
| | - Elvis J Arteaga
- Department of Internal MedicineUniversity of CaliforniaDavis, SacramentoCA
| | - Souvik Sarkar
- Department of Internal MedicineUniversity of CaliforniaDavis, SacramentoCA
- Division of Gastroenterology and HepatologyUniversity of CaliforniaDavis, SacramentoCA
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