Kim Rebecca G, Patel Shyam, Shui Amy M, Magee Catherine, Chen Jennifer Y, Tana Michele, Khalili Mandana
Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah.
Department of Medicine, California Pacific Medical Center, San Francisco, California.
Gastro Hep Adv. 2025 May 27;4(9):100710. doi: 10.1016/j.gastha.2025.100710. eCollection 2025.
Steatotic liver disease (SLD) is strongly associated with diabetes. These diseases disproportionately impact marginalized populations, for whom lifestyle modifications, a mainstay of treatment, can be challenging. This study aimed to assess change in liver enzyme alanine aminotransferase (ALT), body mass index (BMI), and hemoglobin A1c (HbA1c) following SLD education in a safety-net health-care system.
From February 2020 to February 2024, participants attended a 60-minute SLD class. Clinical measures were collected at baseline and posteducation. Baseline factors associated with change in ALT, BMI, and HbA1c were assessed using linear mixed-effects modeling. Factors associated with ALT normalization were assessed using competing risk analyses.
Among the 392 participants, median age was 53 years, 58% women, 53% Hispanic, and 36% had diabetes. Hypertension and hyperlipidemia were more common among patients with diabetes. Overall, 330 attended the SLD class. On multivariable analysis, obesity was associated with lesser change in ALT; age was associated with lesser change in BMI; and race or ethnicity and higher ALT were associated with lesser change in HbA1c. Among patients with abnormal baseline ALT (N = 201), posteducation motivation to adhere to lifestyle modifications was associated with increased likelihood of persistent ALT normalization. No significant differences were observed based on diabetes status.
In this longitudinal study of an SLD education intervention, patients with diabetes achieved a similar ALT reduction to patients without diabetes. Higher posteducation motivation was associated with increased likelihood of sustained ALT normalization. Future studies should assess the impact of education on adaptation of lifestyle modifications and clinical outcomes among vulnerable populations.
脂肪性肝病（SLD）与糖尿病密切相关。这些疾病对边缘化人群的影响尤为严重，而作为主要治疗手段的生活方式改变对他们来说可能具有挑战性。本研究旨在评估在安全网医疗系统中开展SLD教育后，肝酶丙氨酸氨基转移酶（ALT）、体重指数（BMI）和糖化血红蛋白（HbA1c）的变化。
2020年2月至2024年2月，参与者参加了一场60分钟的SLD课程。在基线和课程结束后收集临床指标。使用线性混合效应模型评估与ALT、BMI和HbA1c变化相关的基线因素。使用竞争风险分析评估与ALT正常化相关的因素。
在392名参与者中，中位年龄为53岁，58%为女性，53%为西班牙裔，36%患有糖尿病。高血压和高脂血症在糖尿病患者中更为常见。总体而言，330人参加了SLD课程。多变量分析显示，肥胖与ALT变化较小有关；年龄与BMI变化较小有关；种族或族裔以及较高的ALT与HbA1c变化较小有关。在基线ALT异常的患者（N = 201）中，课程结束后坚持生活方式改变的动机与持续ALT正常化的可能性增加有关。未观察到基于糖尿病状态的显著差异。
在这项关于SLD教育干预的纵向研究中，糖尿病患者的ALT降低程度与非糖尿病患者相似。课程结束后较高的动机与ALT持续正常化的可能性增加有关。未来的研究应评估教育对弱势群体生活方式改变的适应情况和临床结局的影响。
