Patel Shyam, Kim Rebecca G, Shui Amy M, Magee Catherine, Lu Maggie, Chen Jennifer, Tana Michele, Huang Chiung-Yu, Khalili Mandana
Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, California.
Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
Gastro Hep Adv. 2024;3(1):84-94. doi: 10.1016/j.gastha.2023.09.012. Epub 2023 Oct 5.
Fatty liver disease (FLD), alcohol-associated and metabolically associated, often coexists. Increase in physical activity is associated with metabolic health and decreased FLD. We aimed to identify factors associated with physical activity and its improvement following FLD education in a racially diverse, vulnerable population.
From February 19, 2020 to December 30, 2022, 314 adults with FLD at safety-net hepatology clinics in San Francisco were surveyed at baseline, immediately after FLD education, and at 6-month follow-up. After collecting clinical and sociodemographic data, logistic regression (adjusted for age, sex, and race/ethnicity) assessed factors associated with physical activity at baseline and its improvement following education.
Participant characteristics in those without vs with any physical activity were median age 49 vs 55 years, 64% vs 56% female, 66% vs 53% Hispanic race/ethnicity, 75% vs 55% obese, and 30% vs 22% consumed heavy alcohol, respectively. On multivariable analysis, older age was the only significant factor associated with physical activity at baseline (relative risk ratio 1.37 per decade increase, 95% confidence interval [CI] 1.07-1.75). Hispanic (vs non-Hispanic) participants had a significantly higher odds of improvement in physical activity (vs no change) 6 months after education (odds ratio 2.36, 95% CI 1.27-4.39). Among those with suboptimal or no physical activity at baseline, participants who consumed heavy alcohol (vs no drinking) had a significantly higher likelihood of achieving optimal physical activity following education (relative risk ratio 1.98, 95% CI 1.05-3.74).
Despite social and structural barriers, FLD education increased uptake of physical activity in vulnerable populations, especially among Hispanic individuals and those consuming heavy alcohol. Implementation of patient-centered education is important for FLD management.
酒精性脂肪性肝病（FLD）和代谢相关脂肪性肝病常并存。增加身体活动与代谢健康及FLD发病率降低相关。我们旨在确定在一个种族多样的弱势群体中，与身体活动及其在FLD教育后改善相关的因素。
从2020年2月19日至2022年12月30日，对旧金山安全网肝病诊所的314名患有FLD的成年人在基线、FLD教育后立即以及6个月随访时进行了调查。收集临床和社会人口学数据后，采用逻辑回归（校正年龄、性别和种族/民族）评估与基线身体活动及其教育后改善相关的因素。
未进行任何身体活动者与进行身体活动者的参与者特征分别为：年龄中位数49岁对55岁，女性分别为64%对56%，西班牙裔种族/民族分别为66%对53%，肥胖者分别为75%对55%，重度饮酒者分别为30%对22%。多变量分析显示，年龄较大是与基线身体活动相关的唯一显著因素（每增加十岁相对风险比为1.37，95%置信区间[CI]为1.07 - 1.75）。西班牙裔（与非西班牙裔相比）参与者在教育后6个月身体活动改善（与无变化相比）的几率显著更高（优势比为2.36，95% CI为1.27 - 4.39）。在基线身体活动不理想或无身体活动的人群中，重度饮酒者（与不饮酒者相比）在教育后达到最佳身体活动水平的可能性显著更高（相对风险比为1.98，95% CI为1.05 - 3.74）。
尽管存在社会和结构障碍，但FLD教育增加了弱势群体的身体活动参与度，尤其是西班牙裔个体和重度饮酒者。实施以患者为中心的教育对FLD管理很重要。
