Long‐term follow‐up of web‐based and group‐based behavioural intervention in NAFLD in a real world clinical setting

Abstract

SummaryBackgroundThe long‐term results of web‐based behavioural intervention in non‐alcoholic fatty liver disease (NAFLD) have not been described in patients followed in specialised centres.AimsTo analyse the long‐term effectiveness of web education compared with the results achieved by a group‐based behavioural intervention in the same years 2012–2014.MethodsWe followed 679 patients with NAFLD (web‐based, n = 290; group‐based, n = 389) for 5 years. Weight loss ≥10% was the primary outcome; secondary outcomes were attrition, changes in liver enzymes and in biomarkers of steatosis (Fatty liver Index) and fibrosis (Fibrosis‐4 index).ResultsThe cohorts differed in age, education, working status and presence of diabetes. Attrition was higher in the web‐based cohort (hazard ratio: 1.53; 95% CI: 1.24–1.88), but not different after adjustment for confounders. Among patients in active follow‐up, 50% lost ≥5% of initial body weight and 19% lost ≥10%, without difference between cohorts. Alanine aminotransferase levels fell to within the normal range in 51% and 45% of web‐ and group‐based cohorts, respectively. Fatty Liver Index declined progressively and, by year 5, it ruled out steatosis in 4.8%, whereas 24.9% were in the indeterminate range. Fibrosis‐4 index increased in both cohorts, driven by age, but the prevalence of cases ruling‐in advanced fibrosis remained very low (around 1%). Improvements in the class of both surrogate biomarkers were associated with ≥5% weight loss.ConclusionsAlthough burdened by attrition, web‐based behavioural intervention is feasible and effective in NAFLD, expanding the cohort involved in behavioural programs and reducing the risk of progressive disease.

Risk of Binge Eating Disorder in Patients With Non-Alcoholic Fatty Liver Disease Screened for Metabolic Features

“…BED patients should be advised that any attempt to lose weight via dietary restriction, the accepted treatment of NAFLD [3][4][5], con icts with the presence of binging episodes; weight loss is not the target of a BED-focused guided self-help program or group-based cognitive-behavioral therapy for eating disorders (CBT-ED), the accepted interventions for this disordered eating pattern. In addition, BED increases attrition rates in subjects with obesity, and attrition is a critical issue during behavior treatment of NAFLD [25].…”

Editorial: Does knowledge about liver disease enhance adherence to lifestyle recommendations? Authors' reply

“…We read with interest the editorial by Drs. Michel and Schattenberg 1 on our recent study reporting the long‐term follow‐up of patients treated with lifestyle modifications for metabolic dysfunction‐associated steatotic liver disease (MASLD) 2 . Very few patients reached a normal body weight and follow‐up was hindered by a high attrition rate, as commonly observed in the treatment of obesity.…”

“…The authors' declarations of personal and financial interests are unchanged from those in the original article 2 …”

Editorial: Does knowledge about liver disease enhance adherence to lifestyle recommendations?

“…5,6 The study by Petroni and colleagues has highlighted the importance and efficacy of a programme centered around behavioural therapy to achieve long-lasting effects in body weight reduction in a follow-up period of 5 years. 7 The impressive numbers in this manuscript are 50% of patients' retention and in that group, 19% achieving ≥10% total body weight loss (TBWL) at five years. This goes back to the rigorous design and commitment of the study team.…”