Cognitive-Behavioral Treatment of Non-alcoholic Fatty Liver Disease: A Propensity Score-Adjusted Observational Study

Moscatiello, Simona ; Di Luzio, Raffaella ; Bugianesi, Elisabetta ; Suppini, Alessandro ; Hickman, Ingrid ; Di Domizio, Silvia ; Della Grave, Riccardo ; Marchesini, Giulio (2011) Cognitive-Behavioral Treatment of Non-alcoholic Fatty Liver Disease: A Propensity Score-Adjusted Observational Study. Obesity, 19 (4). pp. 763-770. ISSN 1930-739X
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Abstract

The effectiveness of cognitive-behavior treatment (CBT) in nonalcoholic fatty liver disease (NAFLD), largely related to overweight/obesity and considered the hepatic expression of the metabolic syndrome (MS), has so far been tested in very limited samples. In a tertiary referral center, consecutively-observed NAFLD subjects were offered a CBT program aimed at weight loss and increased physical activity, based on 13 group sessions; 68 cases entered the treatment protocol, those who refused (n=82) were given recommendations for diet and physical activity. Treatment goals (weight loss ≥ 7% initial b.w., normalization of liver enzymes and improved parameters of MS) were tested by logistic regression at 6 months (all cases) and at 2 years, both on intention-to-treat (ITT) and in completers (Diet, 78; CBT, 65). The results were adjusted for the propensity score of attending the CBT program, based on civil, anthropometric and clinical variables. At baseline the CBT group had a larger prevalence of obesity and more severe insulin resistance (HOMA assessment). At follow-up, CBT was associated with a higher probability of weight loss and normal liver enzymes (6 month: odds ratio (OR), 2.56; 95% confidence interval (CI), 1.15-5.69; 2-year ITT: OR, 3.57, 95% CI, 1.59-8.00), after adjustment for propensity and changes in body weight. A similar trend was observed in the outcome goals of insulin resistance and the score of MS, which were both reduced. In conclusion, subjects with NAFLD participating in a CBT program significantly improve their general and liver parameters. The beneficial effects are largely maintained at 2-year follow-up, in keeping with the lifestyle-related pathogenesis of disease.

Abstract
Document type
Article
Creators
CreatorsAffiliationORCID
Moscatiello, Simona
Di Luzio, Raffaella
Bugianesi, Elisabetta
Suppini, Alessandro
Hickman, Ingrid
Di Domizio, Silvia
Della Grave, Riccardo
Marchesini, Giulio
Keywords
Behavior Therapy, Liver Disease, Weight Management Program, Physical Fitness
Subjects
ISSN
1930-739X
DOI
Deposit date
06 Sep 2011 09:02
Last modified
26 Feb 2016 10:39
Project name
FLIP - Fatty liver: Inhibition of Progression
Funding program
EC - FP7
URI

Other metadata

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