Patients with non-alcoholic liposuction diseases (NAFLDs) who participated in a web-based lifestyle modification intervention achieved similar levels of weight loss and faster normalization of their liver enzymes than patients who participated in an intensive group-based program. The results of this Italian study, presented today at the International Liver Congress 2018 in Paris, France, also suggested that the degree of weight loss achieved by some patients in both intervention groups was likely to have resulted in fibrosis regression.
"We were impressed that more than one in 10 patients in both intervention groups achieved a weight loss goal of 10%," said Professor Giulio Marchesini from Bologna, Italy, who presented the survey results. "This weight loss threshold has been associated with dissolution of non-alcoholic stomathepatitis and regression of fibrosis in studies that have evaluated NAFLD histology."
NAFD is the most common liver disease in western countries and is characterized by excessive accumulation of fat absorption. The global incidence of NAFDD has been estimated to reach 25% of adults, and both genetic and lifestyle factors contribute to pathogenesis of the disease. Lifestyle modifications aimed at weight loss, increased physical activity and improved dietary habits are central to NAFLD management, and structured intervention programs are recommended in the guidelines.
"Lifestyle changes are mandatory for patients with NAFLD but it is very difficult to achieve in busy clinical units," explained Prof. Marchesini. "We wanted to develop a web-based program to help them achieve these changes and compare the effects with a structured face-to-face involving a multidisciplinary team. Patients' participation in NAFLDs in structured lifestyle programs can be compromised through work and other time constraints, and a web-based involvement may be better suited for young, busy patients. "
The study by Professor Marchesini and colleagues included 71
According to Professor Marchesini, the body mass index in both groups decreased by almost 2 points and the goal of weight loss of 10% was achieved by 14% of all participants (12% of participants in the web-based intervention and 15% in group-based intervention). All liver enzymes decreased significantly, regardless of the procedure, but subjects in the web-based procedure were more likely than those in the group intervention to have a normal alanine aminotransferase level (ALT) at both 6 months (OR 2.34; 95% CI 1.27, 4.30 ) and 12 months (OR 2.22; 95% Ci 1.33, 3.73). Surrogate markers of fibrosis decreased in both intervention groups, with statistically significant improvements from baseline observed in the Fibrosis-4 (FIB-4) index.
"Our study has shown that a web-based lifestyle modification program is a viable and practical way to achieve a clinically meaningful level of weight loss in our NAFLD patients," said Professor Marchesini. "Ideally, we would now like to roll out intervention to other deliveries."
"Weight loss has long been recognized as an effective NAFLD therapy, but the challenge has created the infrastructure to achieve it," said Prof Phil Newsome of Queen Elizabeth Hospital and University of Birmingham, Birmingham, UK and EASL's board member. "Most studies have used conventional resource-intensive regimens that are not widely available in most clinical methods. This study by Prof. Marchesini shows the potential of web-based methods to achieve this on a large scale. The challenge now is to see if patients can maintain weight loss for longer periods. "
Guidelines updated for diagnosis, management of NAFLD