A web-based program is as effective as group counseling for patients with non-alcoholic fatty liver disease

October 2, 2018, Elsevier
The percent weight loss over two years in the two groups treated by either group-based or web-based educational programs. Credit: Journal of Hepatology

Lifestyle changes are the cornerstone of preventing and treating non-alcoholic fatty liver disease (NAFLD). Scientists report success in using web-based intervention to manage lifestyle changes in patients with NAFLD in a new six-year single-center study comparing group-based and web-based interventions. Their results are published in the Journal of Hepatology.

NAFLD is becoming a major global public health problem in parallel with epidemics of obesity and diabetes, and the costs associated with of metabolic origin and its complications are soon likely to outweigh the costs of liver diseases of viral origin. Clinical practice guidelines, including the recent EASL guidelines shared by the Liver, Diabetes and Obesity Societies, recommend to prevent and treat the disease. However, participation of NAFLD patients in structured lifestyle programs may be jeopardized by job demands, distance from treatment center, and time constraints.

Investigators hypothesized that using an Internet-based approach to educate, counsel, and induce permanent changes in motivated and engaged NAFLD patients would expand lifestyle to a much larger community, reducing attendance to busy liver units and sparing patients' and physicians' time. The study was designed to measure the two-year effectiveness of a web-based educational intervention aimed at lifestyle changes, including healthy diet, habitual physical activity, and in individuals with NAFLD.

"Lifestyle changes are pivotal for the treatment of NAFLD. The use of web-based education tools in the management of non-communicable diseases has long been suggested, considering the huge number of cases at risk and patients' needs. Web-based programs might help maintain contact between patients and therapists, since the majority of cases are in an age range in which job constraints make it difficult to use a systematic face-to-face or group approach," explained lead investigator Giulio Marchesini, MD, "Alma Mater" University, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy.

Investigators translated their validated group counseling program (five sessions carried out in groups of 15-20 patients at fixed days and hours) into a web-based program accessible by user ID and password, allowing remote interaction with the center. More than 700 consecutive NAFLD patients with a mean age of 52 were treated in the Unit of Metabolic Diseases and Clinical Dietetics at the University of Bologna from January 2010 to December 2015 with structured programs. One third of all patients had type 2 diabetes.

The primary aim was to reduce weight by ten percent. The established group-based protocol included motivational interviewing and a group-based intervention chaired by physicians, dietitians, and psychologists (five weekly meetings). Patients who could not attend the group-based intervention entered the web-based intervention that included interactive games, learning tests, motivational tests, and email contact with the Center. All patients were seen every six months and the anthropometric and clinical parameters of 278 cases entered in the web program were compared with those of 438 patients attending the regular group-based educational program. The two groups were comparable in terms of obesity, but the web intervention group was characterized by younger age, higher prevalence of males, and higher education.

The study concluded that a web-based, interactive intervention coupled with a face-to-face meeting every six months is as effective as a standard group-based intervention. After two years the probability of reaching the primary outcome of ten percent weight loss was similar in both groups although with a higher attrition rate in the web program. Liver enzymes decreased in both groups and normalized more frequently in the web-treated group. Dietary intake was reduced, and physical activity increased in both groups. Steatosis (buildup of fat within the liver) and fibrosis (the accumulation of scar tissue), which are markers of NAFLD, were evaluated during the study period by non-invasive markers. Steatosis was reduced in both groups, and fibrosis remained stable or decreased without differences between groups.

"Counseling is an effective therapeutic option until drugs in development to treat NAFLD are approved by regulatory agencies, and it will continue to be key to managing weight loss to remove the primary cause of NAFLD," commented Professor Marchesini. "Web counseling to stimulate healthier lifestyles is an effective alternative to group-based counseling and may be a feasible option for busy liver units considering the high number of cases that need to be educated. It is also well appreciated by , saving time for actively working individuals."

Explore further: A Web-based lifestyle intervention supports weight loss in patients with non-alcoholic fatty liver disease

More information: "An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers," Journal of Hepatology, DOI: 10.1016/j.jhep.2018.07.013

Related Stories

A Web-based lifestyle intervention supports weight loss in patients with non-alcoholic fatty liver disease

April 13, 2018
Patients with non-alcoholic fatty liver disease (NAFLD) who participated in a web-based lifestyle modification intervention achieved similar levels of weight loss and more rapid normalization of their liver enzymes than patients ...

New tool to detect fatty liver disease before liver damage

September 12, 2018
A new test may soon be available to predict advanced fibrosis in people with non-alcoholic fatty liver disease (NAFLD).

Family of patients with NAFLD and cirrhosis are at increased risk of liver fibrosis

June 19, 2017
Non-alcoholic fatty liver disease (NAFLD) is a common disorder characterized by abnormal accumulation of fat in the liver. NAFLD is diagnosed in up to one in three adults and one in 10 children in the United States, and obesity ...

More protein after weight loss may reduce fatty liver disease

August 16, 2018
Increasing the amount of protein in the diet may reduce the liver's fat content and lower the risk of diabetes in people with nonalcoholic fatty liver disease (NAFLD). The study is published ahead of print in the American ...

Guidelines updated for diagnosis, management of NAFLD

July 19, 2017
(HealthDay)—A practice guidance statement, published online July 17 in Hepatology, has been developed to augment the clinical practice guidelines for the diagnosis and management of non-alcoholic fatty liver disease (NAFLD).

Study finds non-alcoholic fatty liver disease is a significant risk factor for liver cancer

August 28, 2018
Non-alcoholic fatty liver disease (NAFLD) is a very common disease, and with the incidence of liver cancer rising across the country, little has been understood about the link between NAFLD and a form of liver cancer called ...

Recommended for you

RNA processing and antiviral immunity

December 14, 2018
The RIG-I like receptors (RLRs) are intracellular enzyme sentries that detect viral infection and initiate a first line of antiviral defense. The cellular molecules that activate RLRs in vivo are not clear.

Faster test for Ebola shows promising results in field trials

December 13, 2018
A team of researchers with members from the U.S., Senegal and Guinea, in cooperation with Becton, Dickinson and Company (BD), has developed a faster test for the Ebola virus than those currently in use. In their paper published ...

Drug targets for Ebola, Dengue, and Zika viruses found in lab study

December 13, 2018
No drugs are currently available to treat Ebola, Dengue, or Zika viruses, which infect millions of people every year and result in severe illness, birth defects, and even death. New research from the Gladstone Institutes ...

Urbanisation and air travel leading to growing risk of pandemic

December 13, 2018
Increased arrivals by air and urbanisation are the two main factors leading to a growing vulnerability to pandemics in our cities, a University of Sydney research team has found.

Researchers discover new interactions between Ebola virus and human proteins

December 13, 2018
Several new connections have been discovered between the proteins of the Ebola virus and human host cells, a finding that provides insight on ways to prevent the deadly Ebola virus from reproducing and could lead to novel ...

Faecal transplants, 'robotic guts' and the fight against deadly gut bugs

December 13, 2018
A simple compound found in our gut could help to stop dangerous bacteria behind severe, and sometimes fatal, hospital infections.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.