Patients with non-alcoholic fatty liver disease (NAFLD) who participated in a web-based lifestyle modification intervention achieved similar levels of weight loss and faster normalization of their liver enzymes than patients who participated in a web-based lifestyle modification intervention. an intensive program based on groups. The results of this Italian study, which was presented today at the 2018 International Liver Congress in Paris, France, also suggested that the degree of weight loss achieved by some patients in both intervention groups has likely resulted in the regression of fibrosis. .
"We were impressed that more than one in 10 patients in both intervention groups achieved a goal of weight loss of 10%," said Professor Giulio Marchesini of the University of Bologna, Italy, who presented the study's findings. . "This threshold of weight loss has been associated with the resolution of nonalcoholic steatohepatitis and the regression of fibrosis in studies that have evaluated NAFLD histology."
NAFLD is the most common liver disease in Western countries and is characterized by an excessive accumulation of liver fat. It is estimated that the global prevalence of NAFLD has reached 25% of adults, and genetic and lifestyle factors contribute to the pathogenesis of the disease. Lifestyle modifications aimed at losing weight, increasing physical activity and improving eating habits are fundamental for the management of NAFLD, and structured intervention programs are recommended in the guidelines.
"Lifestyle changes are mandatory for patients with NAFLD, but these are very difficult to achieve in busy clinical units," explained Prof. Marchesini. "We wanted to develop a web-based program to help them achieve these changes and compare their effects with a structured face-to-face program involving a multidisciplinary team.The participation of patients with NAFLD in structured lifestyle programs can be compromised by work and other time constraints, and a web-based intervention may be more appropriate for young and busy patients. "
The study conducted by Prof. Marchesini and his colleagues included 716 patients with NAFLD. They attended a 5-week intensive group lifestyle modification program, created by a multidisciplinary team of doctors, dieticians, and psychologists who encouraged a healthy diet and regular physical activity (n = 438) or participated in a web-based intervention (n = 278). The web-based program included five modules, with interactive games, offline contact with the study center and questionnaires. The surrogate markers of the severity of NAFLD were analyzed at 6, 12 and 24 months of follow-up. The main outcome measure for the study was the percentage of patients who achieved a weight loss of 10%.
According to Professor Marchesini, the body mass index decreased in both groups by almost 2 points, and the goal of weight loss of 10% was achieved by 14% of all participants (12% of participants in the intervention based on the web and 15% in group intervention). All liver enzymes decreased significantly, regardless of intervention, but individuals in the web-based intervention were more likely than those in the group intervention to have a normal level of alanine aminotransferase (ALT) at 6 months (OR 2, 34, 95% CI 1.27, 4.30) and 12 months (OR 2.22, 95% CI 1.33, 3.73). Substitutive fibrosis markers decreased in both intervention groups, with statistically significant improvements with respect to the initial value observed in the Fibrosis-4 index (FIB-4).
"Our study has shown that a web-based lifestyle modification program is feasible and practical way to achieve a clinically meaningful level of weight loss in our NAFLD patients," said Prof. Marchesini. "Ideally, we would now like to extend the intervention to other liver units."
"Weight loss has long been recognized as an effective therapy for NAFLD, but the challenge has been to create the infrastructure to achieve it," said Professor Phil Newsome of Queen Elizabeth Hospital and the University of Birmingham, Birmingham, United Kingdom, and member of the Governing Board of EASL. "Most studies have used conventional resource-intensive regimens that are not widely available in most clinical practices." This study by Prof. Marchesini demonstrates the potential of web-based approaches to achieve this on a large scale. The challenge now will be to see if patients are able to withstand weight loss for longer periods of time. "
Updated guidelines for the diagnosis and management of NAFLD