Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
Hepatol Commun. 2023 Aug 3;7(8). doi: 10.1097/HC9.0000000000000224. eCollection 2023 Aug 1.
Clinically significant weight loss-which requires sustained dietary and physical activity changes-is central to treating NAFLD. Although behavioral interventions have demonstrated effectiveness in promoting weight loss among primary prevention populations, the data are limited among patients with NAFLD who need weight loss for treatment. We undertook this scoping review to map the existing data on the characteristics, weight-loss outcomes, and determinants of success of interventions evaluated among patients with NAFLD.
We searched Medline, EMBASE, Cochrane, PsycINFO, and Web of Science from inception to January 1, 2023 to identify publications reporting weight loss among adults with NAFLD in behavioral weight-loss interventions. We summarized interventions and classified them as successful if there was an average weight loss of ≥ 5% from baseline across enrolled participants or achieved by ≥ 50% of enrolled participants.
We included 28 studies: 10 randomized control trials, ten quasi-experimental, and 8 observational studies. Intervention delivery, duration, and counseling frequency varied; 12 were successful. Retention was highest among telephone interventions and lowest among "real-world" face-to-face interventions. Patients who were women, younger, and/or had multiple metabolic conditions were most likely to dropout. Successful interventions had biweekly counseling, specific physical activity, and calorie targets, behavioral theory grounding, and promoted goal-setting, self-monitoring, and problem-solving.
There are limited data on behavioral weight-loss interventions in NAFLD. Research is needed to develop effective interventions generalizable to diverse patient populations and that maximize adherence, particularly among patients who are diabetic, women, and younger.
临床意义上的体重减轻——需要持续的饮食和身体活动改变——是治疗非酒精性脂肪性肝病（NAFLD）的核心。尽管行为干预已被证明在促进初级预防人群体重减轻方面有效，但在需要减肥治疗的 NAFLD 患者中，数据有限。我们进行了这项范围性综述，以绘制现有数据，这些数据涉及在需要减肥治疗的 NAFLD 患者中评估的干预措施的特征、体重减轻结果和成功决定因素。
我们从建库到 2023 年 1 月 1 日在 Medline、EMBASE、Cochrane、PsycINFO 和 Web of Science 上进行了检索，以确定报告在行为性体重减轻干预中 NAFLD 成人体重减轻的出版物。我们总结了干预措施，并将其分类为成功，如果所有参与者的平均体重减轻≥基线的 5%，或者≥50%的参与者达到这一目标。
我们纳入了 28 项研究：10 项随机对照试验、10 项准实验和 8 项观察性研究。干预措施的实施、持续时间和咨询频率各不相同；其中 12 项是成功的。电话干预的保留率最高，而“真实世界”面对面干预的保留率最低。女性、年轻和/或患有多种代谢疾病的患者最有可能退出。成功的干预措施有两周一次的咨询、特定的体力活动和卡路里目标、行为理论基础，并促进目标设定、自我监测和解决问题。
关于 NAFLD 的行为性体重减轻干预措施的数据有限。需要研究开发可推广到不同患者群体的有效干预措施，并最大限度地提高依从性，特别是在糖尿病、女性和年轻患者中。
