IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
Aliment Pharmacol Ther. 2024 Jan;59(2):249-259. doi: 10.1111/apt.17768. Epub 2023 Oct 16.
The 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.
To 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.
We 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).
The 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.
Although 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.
在专门中心随访的患者中，尚未描述基于网络的非酒精性脂肪性肝病（NAFLD）行为干预的长期结果。
分析与同年（2012-2014 年）进行的基于小组的行为干预相比，网络教育的长期有效性。
我们随访了 679 例 NAFLD 患者（网络组，n=290；基于小组的干预组，n=389），随访时间为 5 年。体重减轻≥10%是主要结果；次要结果是流失、肝酶变化以及脂肪变性（脂肪肝指数）和纤维化（纤维化 4 指数）的生物标志物变化。
两组在年龄、教育程度、工作状态和糖尿病的存在方面存在差异。网络组的流失率更高（风险比：1.53；95%可信区间：1.24-1.88），但在调整混杂因素后无差异。在积极随访的患者中，50%的患者减轻了初始体重的≥5%，19%的患者减轻了≥10%，两组之间没有差异。丙氨酸氨基转移酶水平降至正常范围，网络组和基于小组的干预组分别为 51%和 45%。脂肪肝指数逐渐下降，到第 5 年，排除脂肪变性的患者比例为 4.8%，而不确定范围的患者比例为 24.9%。纤维化 4 指数在两个队列中均增加，主要由年龄驱动，但诊断为晚期纤维化的病例比例仍然很低（约 1%）。替代生物标志物类别的改善与≥5%的体重减轻相关。
尽管存在流失，但基于网络的行为干预在 NAFLD 中是可行且有效的，扩大了参与行为项目的患者群体，并降低了疾病进展的风险。
