M. Romeo, M. Dallio, F. Di Nardo, A. Coppola, P. Vaia, C. Napolitano, G. Martinelli, S. Olivieri, M. Niosi, A. Federico
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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":"56 ","pages":"Pages S318-S319"},"PeriodicalIF":4.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"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\":\"M. Romeo, M. Dallio, F. Di Nardo, A. Coppola, P. Vaia, C. Napolitano, G. Martinelli, S. Olivieri, M. Niosi, A. 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引用次数: 0
摘要
导言:改变生活方式是代谢功能障碍相关性脂肪肝(MASLD)的主要治疗手段。遗憾的是,饮食行为处方一直受到依从性差的限制。目的 评估多学科(肝病学家-营养学家-心理学家)管理在改善 MASLD 临床疗效方面的有效性,方法是改善对专门定制适应症的依从性:72名患者遵循肝病医生提供的一般饮食建议("H"),71名患者同时接受营养师开具的个性化干预("HN")(H+N="标准护理"),143名患者接受了额外的认知/行为心理支持方法("HNP")("实验组")。在基线期,记录了人体测量、生化、临床、肝脏硬度(LSM)、受控衰减参数(CAP)、生活习惯和身体成分值。结果18个月后,HNP患者体重下降≥10%的比例明显更高(HNP:62.09%;HN:44.9%;H:35.8%;HNP vs HN,P:0.01;HNP vs H,P:0.0002)。在 HNP 中,胰岛素抵抗的稳态模型评估(Homeostatic-model-assessment-for-insulin-resistance)(p:0.001)、高密度脂蛋白(HDL)(p<0.0001)、低密度脂蛋白(LSM)(p:0.007)、CAP(p:0.002)和脂肪量(Fat-Mass)(p<0.0001)均有明显改善。HNP 患者的顺应性丧失率明显较低(HNP:12.08%;HN:34.7%;H:45.8%;HNP vs HN,HNP vs H,p:0.001)。与此相关的是,HNP 患者在观察期间发生急性心血管事件(ACE)的风险明显较低[HR:0.497,IC(0.236-0.751)95%,P:0.04](图)。逻辑回归分析(调整了性别、年龄和心血管风险因素)显示,坚持 HNP 与降低 ACEs 发生率显著相关(aOR:0.81;C.I. 95%:0.55-0.97;p:0.02)。动态工作、城市生活和大家庭成为影响依从性的社会因素(OR:2.11、1.78、1.12)(均为 p<0.05)。
Multidisciplinary management combining hepatologist counseling, cognitive/behavioral therapy, and nutritional support significantly improves clinical outcomes of Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) patients
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.