Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy.
Section of Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Palermo, Italy.
J Hepatol. 2018 Nov;69(5):1155-1163. doi: 10.1016/j.jhep.2018.07.013. Epub 2018 Oct 2.
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.
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.
GBI and WBI cohorts had similar body mass index (mean, 33 kg/m), 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).
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.
In patients with non-alcoholic fatty liver disease, participation in structured lifestyle programs may be jeopardized by job and time constraints. A web-based intervention may be better suited for young, busy patients, and for those living far from liver units. The study shows that, following a structured motivational approach, a web-based, interactive intervention coupled with six-month face-to-face meetings is not inferior to a standard group-based intervention with respect to weight loss, adherence to healthy diet and habitual physical activity, normalization of liver enzymes, and stable surrogate markers of fibrosis.
针对生活方式改变的干预措施是非酒精性脂肪性肝病（NAFLD）治疗的关键，基于网络的方案可能有助于消除患者和治疗师两方面的障碍。
在 2010 年至 2015 年期间，我们科室采用结构化方案治疗了 716 例连续的 NAFLD 病例（平均年龄 52 岁；2 型糖尿病 33%）。常规方案包括动机访谈和基于小组的干预（GBI），由医生、营养师和心理学家主持（每周 5 次会议，n=438）。无法参加 GBI 的患者则进入基于网络的干预（WBI），WBI 源自 GBI，包括互动游戏、学习测试、动机测试和与中心的邮件联系。主要结局是体重减轻≥10%；次要结局是丙氨酸氨基转移酶恢复正常、生活方式改变、体重、丙氨酸氨基转移酶和脂肪变性及纤维化的替代标志物。
GBI 和 WBI 队列的体重指数（BMI）相似（平均 33kg/m），但 WBI 队列中男性更多（67%比 45%）、年龄更小、受教育程度更高、体力活动更多。WBI 组的两年失访率更高。两组均观察到健康的生活方式改变，BMI 下降近 2 个点；WBI 组 20%的患者达到 10%的体重目标，而 GBI 组为 15%（无显著差异）。在调整混杂因素和失访率的逻辑回归分析中，WBI 与达到短期和长期 10%体重目标的患者比例减少无关。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（非酒精性脂肪性肝病纤维化评分）或同样降低（Fib-4）。
WBI 在改善 NAFLD 的组织学结局方面与显著的临床结局相关，因此与常见的生活方式方案一样有效。电子健康计划可能有效地有助于 NAFLD 的控制。
背景与目的：非酒精性脂肪性肝病（NAFLD）的治疗关键是生活方式的改变，网络方案可能有助于消除医患双方的障碍。
方法：2010-2015 年，716 例 NAFLD 患者（平均年龄 52 岁，2 型糖尿病占 33%）在我科接受结构化方案治疗。常规方案包括动机访谈和以医生、营养师和心理学家为主导的小组干预（每周 5 次会议，n=438）。无法参加小组干预的患者则进入网络干预（n=278），网络干预基于小组干预设计，包括互动游戏、学习测试、动机测试和与中心的邮件联系。主要结局是体重减轻≥10%；次要结局是丙氨酸氨基转移酶恢复正常、生活方式改变、体重、丙氨酸氨基转移酶和脂肪变性及纤维化的替代标志物。
结果：GBI 和 WBI 组的体重指数（BMI）相似（平均 33kg/m），但 WBI 组男性更多（67%比 45%）、年龄更小、受教育程度更高、体力活动更多。WBI 组的两年失访率更高。两组均观察到健康的生活方式改变，BMI 下降近 2 个点；WBI 组 20%的患者达到 10%的体重目标，而 GBI 组为 15%（无显著差异）。在调整混杂因素和失访率的逻辑回归分析中，WBI 与达到短期和长期 10%体重目标的患者比例减少无关。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（非酒精性脂肪性肝病纤维化评分）或同样降低（Fib-4）。
结论：WBI 在改善 NAFLD 的组织学结局方面与显著的临床结局相关，因此与常见的生活方式方案一样有效。电子健康计划可能有效地有助于 NAFLD 的控制。
