{"title":"Multidisciplinary management combining hepatologist counseling, cognitive/behavioral therapy, and nutritional support significantly improves clinical outcomes of Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) patients","authors":"","doi":"10.1016/j.dld.2024.08.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Lifestyle modifications represent the main therapeutic intervention for Metabolic dysfunction-associated Steatotic Liver disease (MASLD). Unfortunately, the dietary-behavioral prescription is constantly limited by poor compliance. In this context, the benefits of motivational support remain unexplored.</p></div><div><h3>Aim</h3><p>To evaluate the effectiveness of a multidisciplinary (hepatologist-nutritionist-psychologist) management in improving clinical outcomes in MASLD, via ameliorating adherence to specialistic tailored-indications.</p></div><div><h3>Materials and Methods</h3><p>MASLD patients (n.286) were consecutively enrolled and randomized in three cohorts: 72 followed generic hepatologist-provided dietary advice (“H”), 71 also received a nutritionists-prescribed individualized intervention (“HN”) (H+N= “standard of care”), and 143 were treated with an approach additionally involving cognitive/behavioral-based psychological support (“HNP”) (“experimental-group”). At baseline, anthropometric, biochemical, clinical, liver stiffness (LSM), controlled attenuation parameter (CAP), lifestyle habits, and body composition values were recorded. Along 18 months, semestral hepatological (for all), nutritional (H and HN), and psychological (HNP) follow-ups reassessed parameters and evaluated compliance.</p></div><div><h3>Results</h3><p>After 18 months, the prevalence of patients achieving a ≥ 10% decrease in body weight was significantly higher in HNP (HNP:62.09%; HN:44.9%; H:35.8%; HNP vs HN, <em>p</em>:0.01; HNP vs H, <em>p</em>:0.0002). In HNP, a significant improvement in Homeostatic-model-assessment-for-insulin-resistance (<em>p</em>:0.001), HDL (<em>p</em><0.0001), LSM (<em>p</em>:0.007), CAP (<em>p</em>:0.002), and Fat-Mass (<em>p</em> < 0.0001) was observed. Loss of compliance rate was significantly lower in HNP (HNP:12.08%; HN:34.7%; H:45.8%; HNP vs HN, HNP vs H, <em>p</em>:0.001). Relevantly, HNP patients presented a significantly lower risk of acute cardiovascular events (ACEs) during the observation period [HR: 0.497, IC (0.236-0.751) 95%, <em>p</em>:0.04)] (Figure). Logistic regression analysis (adjusted for sex, age, and cardiovascular risk factors) revealed HNP adherence as significantly associated with lower ACEs occurrence (aOR: 0.81; C.I. 95%: 0.55-0.97; p:0.02). Dynamic work, city life, and large family emerged as social factors influencing compliance (OR: 2.11, 1.78, 1.12) (all <em>p</em><0.05).</p></div><div><h3>Conclusions</h3><p>Integrating standard hepatological-nutritional with psychological support significantly improves the outcomes of MASLD patients.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive and Liver Disease","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1590865824009289","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Lifestyle modifications represent the main therapeutic intervention for Metabolic dysfunction-associated Steatotic Liver disease (MASLD). Unfortunately, the dietary-behavioral prescription is constantly limited by poor compliance. In this context, the benefits of motivational support remain unexplored.
Aim
To evaluate the effectiveness of a multidisciplinary (hepatologist-nutritionist-psychologist) management in improving clinical outcomes in MASLD, via ameliorating adherence to specialistic tailored-indications.
Materials and Methods
MASLD patients (n.286) were consecutively enrolled and randomized in three cohorts: 72 followed generic hepatologist-provided dietary advice (“H”), 71 also received a nutritionists-prescribed individualized intervention (“HN”) (H+N= “standard of care”), and 143 were treated with an approach additionally involving cognitive/behavioral-based psychological support (“HNP”) (“experimental-group”). At baseline, anthropometric, biochemical, clinical, liver stiffness (LSM), controlled attenuation parameter (CAP), lifestyle habits, and body composition values were recorded. Along 18 months, semestral hepatological (for all), nutritional (H and HN), and psychological (HNP) follow-ups reassessed parameters and evaluated compliance.
Results
After 18 months, the prevalence of patients achieving a ≥ 10% decrease in body weight was significantly higher in HNP (HNP:62.09%; HN:44.9%; H:35.8%; HNP vs HN, p:0.01; HNP vs H, p:0.0002). In HNP, a significant improvement in Homeostatic-model-assessment-for-insulin-resistance (p:0.001), HDL (p<0.0001), LSM (p:0.007), CAP (p:0.002), and Fat-Mass (p < 0.0001) was observed. Loss of compliance rate was significantly lower in HNP (HNP:12.08%; HN:34.7%; H:45.8%; HNP vs HN, HNP vs H, p:0.001). Relevantly, HNP patients presented a significantly lower risk of acute cardiovascular events (ACEs) during the observation period [HR: 0.497, IC (0.236-0.751) 95%, p:0.04)] (Figure). Logistic regression analysis (adjusted for sex, age, and cardiovascular risk factors) revealed HNP adherence as significantly associated with lower ACEs occurrence (aOR: 0.81; C.I. 95%: 0.55-0.97; p:0.02). Dynamic work, city life, and large family emerged as social factors influencing compliance (OR: 2.11, 1.78, 1.12) (all p<0.05).
Conclusions
Integrating standard hepatological-nutritional with psychological support significantly improves the outcomes of MASLD patients.
期刊介绍:
Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD).
Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology.
Contributions consist of:
Original Papers
Correspondence to the Editor
Editorials, Reviews and Special Articles
Progress Reports
Image of the Month
Congress Proceedings
Symposia and Mini-symposia.