Bollinger Bryan, Cotter Robert, Deng Yanhong, Ilagan-Ying Ysabel, Gupta Vikas
Yale University School of Medicine, New Haven, CT, USA.
Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA.
Dig Dis Sci. 2025 Jan;70(1):378-385. doi: 10.1007/s10620-024-08724-y. Epub 2024 Nov 27.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and resultant steatohepatitis (MASH) have been linked to psychiatric comorbidities. The treatment of MASLD/MASH primarily relies upon weight loss, where achieving a 7% total body weight loss is recommended to improve steatohepatitis. We aimed to determine whether achieving a 7% total body weight loss (TBWL) in MASLD/MASH patients was significantly different in the presence of a mood and/or anxiety disorder in an interdisciplinary clinic that integrates weight management and hepatology care.
We conducted a single center retrospective cohort study of MASLD/MASH patients segregated into those with an ICD-10 diagnosis of a mood and/or anxiety disorder to those without. The primary outcome was reaching a 7% TBWL at 12 months with univariable and multivariable logistic regression models used to identify treatments predicting a 7% TBWL. Secondary outcomes were noninvasive assessment of steatohepatitis improvement, including change in ALT and FIB-4 scores.
Of 567 patients with MASLD/MASH, 366 (64.6%) had a mood and/or anxiety disorder. The presence of psychiatric disease was not a significant predictor of weight loss or any secondary outcome measures at 12 months. Significant predictors of achieving 7% TBWL at 12 months among all patients with MASLD/MASH included semaglutide, phentermine-topiramate, and bariatric surgery. Significant predictors of achieving 7% TBWL at 12 months in patients with MASLD/MASH and a psychiatric comorbidity included semaglutide, topiramate, phentermine-topiramate, and bariatric surgery. Both groups experienced similar improvements in hepatic outcomes.
Our findings suggest that obesity management in patients with MASLD/MASH performs similarly in the presence of comorbid mood and/or anxiety disorders. Topiramate and phentermine may be particularly effective in this patient population, yet are underutilized in routine hepatology practice.
代谢功能障碍相关脂肪性肝病（MASLD）及由此导致的脂肪性肝炎（MASH）与精神疾病共病有关。MASLD/MASH的治疗主要依赖于体重减轻，建议体重减轻7%以改善脂肪性肝炎。我们旨在确定在一个整合体重管理和肝病护理的跨学科诊所中，患有情绪和/或焦虑症的MASLD/MASH患者实现7%的总体重减轻（TBWL）是否存在显著差异。
我们对MASLD/MASH患者进行了一项单中心回顾性队列研究，将其分为有国际疾病分类第十版（ICD-10）诊断的情绪和/或焦虑症患者与无此类诊断的患者。主要结局是在12个月时达到7%的TBWL，使用单变量和多变量逻辑回归模型来确定预测7%TBWL的治疗方法。次要结局是对脂肪性肝炎改善情况的无创评估，包括谷丙转氨酶（ALT）和FIB-4评分的变化。
在567例MASLD/MASH患者中，366例（64.6%）患有情绪和/或焦虑症。精神疾病的存在并非12个月时体重减轻或任何次要结局指标的显著预测因素。在所有MASLD/MASH患者中，12个月时实现7%TBWL的显著预测因素包括司美格鲁肽、芬特明-托吡酯和减肥手术。在患有MASLD/MASH且有精神疾病共病的患者中，12个月时实现7%TBWL的显著预测因素包括司美格鲁肽、托吡酯、芬特明-托吡酯和减肥手术。两组患者的肝脏结局均有相似程度的改善。
我们的研究结果表明，患有MASLD/MASH的患者在合并情绪和/或焦虑症的情况下，肥胖管理效果相似。托吡酯和芬特明在这类患者群体中可能特别有效，但在常规肝病治疗中未得到充分利用。
