CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome 00168, Italy.
World J Gastroenterol. 2024 Jul 7;30(25):3143-3146. doi: 10.3748/wjg.v30.i25.3143.
In this editorial we comment on the article titled "Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease" by Zeng published in a recent issue of the . Non-alcoholic fatty liver disease (NAFLD) represents one of the current challenges in hepatology and public health, due to its continuous growing prevalence and the rising incidence of NAFLD-related fibrosis, non-alcoholic steatohepatitis and cirrhosis. The only effective therapeutic strategy for this disease is represented by encouraging patients to improve their lifestyle through the modification of dietary intake and increased physical exercise, but the effective application of such modifications is often limited by various factors such as lack of information, psychological barriers or poor social support. While poor adherence to a healthy lifestyle can be decisive in determining the clinical outcome, in daily practice there is a lack of quantitative instruments aimed at identifying patients with the lowest adherence to lifestyle changes and higher risk of disease progression in the course of follow-up. In this article, Zeng propose a quantitative scale to assess the grade of adherence of patients with NAFLD to healthy lifestyle intervention, called the Exercise and Diet Adherence Scale (EDAS). This scale, consisting of 33 items divided into 6 dimensions which relates to six subjective aspects in the self-management of NAFLD, has shown a good correlation with the identification of the sub-cohort of patients with the highest reduction in caloric intake, increase in physical exercise, probability of a reduction in liver stiffness measurement and alanine aminotransferase levels. The correlation among clinical outcomes and specific dimensions of this scale also highlights the pivotal role of a good and confidential doctor-patient relationship and of an effective communication. There is an urgent need for practical and effective instruments to assess the grade of self-management of NAFLD patients, together with the development of multidisciplinary teams with the aim of applying structured behavioral interventions.
在这篇社论中，我们对曾[1]发表在最近一期[2]上的题为“建立和验证非酒精性脂肪性肝病生活方式干预依从性预测系统”的文章进行了评论。非酒精性脂肪性肝病（NAFLD）是当前肝病学和公共卫生领域的挑战之一，因为其患病率持续增长，NAFLD 相关纤维化、非酒精性脂肪性肝炎和肝硬化的发病率也在上升。这种疾病唯一有效的治疗策略是通过改变饮食摄入和增加体育锻炼来鼓励患者改善生活方式，但这些改变的有效应用往往受到各种因素的限制，如缺乏信息、心理障碍或不良的社会支持。虽然不良的生活方式依从性可能对决定临床结果具有决定性作用，但在日常实践中，缺乏旨在识别对生活方式改变依从性最低、疾病进展风险最高的患者的定量工具。在这篇文章中，曾[1]提出了一种评估 NAFLD 患者对健康生活方式干预依从性的定量量表，称为运动和饮食依从性量表（EDAS）。该量表由 33 个项目组成，分为 6 个维度，与 NAFLD 自我管理的 6 个主观方面有关，与识别卡路里摄入减少最多、体力活动增加、肝硬度测量和丙氨酸氨基转移酶水平降低概率最高的患者亚组具有良好的相关性。该量表的临床结局与特定维度之间的相关性也突出了良好的医患关系和有效的沟通的关键作用。迫切需要实用有效的工具来评估 NAFLD 患者的自我管理程度，并建立多学科团队，以实施结构化的行为干预。
