结合肝病专家咨询、认知/行为疗法和营养支持的多学科管理能显著改善代谢功能障碍相关性脂肪性肝病(MASLD)患者的临床疗效

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.009
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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)。
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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.

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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
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.
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