An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers
An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers
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DOI：
10.1016/j.jhep.2018.07.013
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发表时间：
2018-11-01
影响因子：
25.7
通讯作者：
Marchesini, Giulio
中科院分区：
文献类型：
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作者：
Mazzotti, Arianna;Caletti, Maria Turchese;Marchesini, Giulio
背景和目标：针对生活方式改变的干预措施是关键的非酒精性脂肪肝疾病（NAFLD）的治疗，和基于网络的程序可能有助于消除障碍，患者和therapists.Methods：在2010年至2015年期间，716例连续NAFLD病例（平均年龄，52; 2型糖尿病，33%）在我们的部门与结构化的程序。通常的协议包括动机访谈和基于组的干预（GBI），由医生，营养师和心理学家主持（每周五次会议，n = 438）。不能参加GBI的个人进入了基于网络的干预（WBI，n = 278）来自GBI，互动游戏，学习测试，动机测试，并与该中心的邮件联系。主要结果是体重减轻>= 10%;次要结果是丙氨酸氨基转移酶在正常范围内，生活方式，体重，丙氨酸氨基转移酶和脂肪变性和纤维化的替代标志物的变化。GBI和WBI队列的体重指数相似（平均33 kg/m2），WBI组中男性更多（67% vs. 45%），年龄更小，受教育程度更高，体力活动更多。WBI组的两年流失率较高。在两组中均观察到健康的生活方式改变，体重指数降低了近两个点; 20%的WBI病例达到了10%的体重目标，而GBI病例为15%（不显著）。在逻辑回归分析中，调整混杂因素和损耗率后，WBI与达到短期和长期10%体重目标的患者减少无关。两组的肝酶均降低，WBI组更常恢复正常。脂肪肝指数降低，而纤维化保持稳定（NAFLD纤维化评分）或类似地降低（纤维蛋白原-4（Fib-4）。结论：WBI的有效性不低于常见的生活方式方案，与改善NAFLD的组织学结局相关的显著临床结局。电子健康计划可以有效地促进NAFLD控制。(C)2018年欧洲肝脏研究协会。由爱思唯尔公司出版
Background & Aims: Interventions aimed at lifestyle changes are pivotal for the treatment of non-alcoholic fatty liver disease (NAFLD), and web-based programs might help remove barriers in both patients and therapists.Methods: In the period 2010-15, 716 consecutive NAFLD cases (mean age, 52; type 2 diabetes, 33%) were treated in our Department with structured programs. The usual protocol included motivational interviewing and a group-based intervention (GBI), chaired by physicians, dietitians and psychologists (five weekly meetings, n = 438). Individuals who could not attend GBI entered a web-based intervention (WBI, n = 278) derived from GBI, with interactive games, learning tests, motivational tests, and mail contacts with the center. The primary outcome was weight loss >= 10%; secondary outcomes were alanine aminotransferase within normal limits, changes in lifestyle, weight, alanine aminotransferase, and surrogate markers of steatosis and fibrosis.Results: GBI and WBI cohorts had similar body mass index (mean, 33 kg/m(2)), with more males (67% vs. 45%), younger age, higher education, and more physical activity in the WBI group. The two-year attrition rate was higher in the WBI group. Healthy lifestyle changes were observed in both groups and body mass index decreased by almost two points; the 10% weight target was reached in 20% of WBI cases vs. 15% in GBI (not significant). In logistic regression analysis, after adjustment for confounders and attrition rates, WBI was not associated with a reduction of patients reaching short- and long-term 10% weight targets. Liver enzymes decreased in both groups, and normalized more frequently in WBI. Fatty liver index was reduced, whereas fibrosis remained stable (NAFLD fibrosis score) or similarly decreased (Fib-4).Conclusion: WBI is not less effective than common lifestyle programs, as measured by significant clinical outcomes associated with improved histological outcomes in NAFLD. eHealth programs may effectively contribute to NAFLD control. (C) 2018 European Association for the Study of the Liver. Published by Elsevier B.V.