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Many patients with NAFLD not ready to make beneficial lifestyle changes

Patients with nonalcoholic fatty liver disease often are not ready to make changes to their diets or activity levels to treat their condition, according to recent results.

Researchers evaluated 138 patients (aged 19 to 73 years; 73% men) with nonalcoholic fatty liver disease (NAFLD) who completed an EMME-3 questionnaire assessing their motivations to change diet and physical activity. Classification stages included precontemplation, contemplation, determination, action and maintenance. Patients also were scored on discrepancy levels (current dissatisfaction and their desire to change), self-efficacy, the importance of their need for a new lifestyle and the temptation of their old lifestyle.

Individual responses were highly variable. Precontemplation was considered the prevalent stage of change for healthy diet in no cases, while contemplation was the prevalent stage in 36%. More than 50% of participants were part of the precontemplation or contemplation stages for change to physical activity.

Women had significantly lower scores than men for the action stage, but had higher discrepancy scores for the diet and physical activity questionnaires. Women also had significantly higher scores for importance regarding physical activity (P<.025 for all).

Determination scores for physical activity were significantly greater among patients with three to five metabolic complications (n=18) than patients with zero to two complications (n=118) (P=.023).

Patients aged 45 years and older had significantly lower contemplation scores for the healthy diet questionnaire than younger participants (P=.024). Older patients also had lower action scores for the activity questionnaire (P=.018), but higher determination (P=.008) and discrepancy scores (P=.019).

Logistic regression analysis indicated age (OR=1.70; 95% CI, 1.20-2.43 per every 10 years) and male sex (OR=4.51; 95% CI, 1.69-12.08) as predictive factors for the precontemplation or contemplation stages regarding healthy diet. No predictive factors were determined for any stages of change to physical activity.

“ … NAFLD patients have a large variability in their readiness to change both their diet and physical activity, and a large subgroup is not ready to enter parallel modification programs on both sides,” the researchers concluded. “Defining stages of change and motivation offers the opportunity to improve clinical care of people with NAFLD through individual programs and specific treatment strategies, exploiting the powerful potential of targeted behavioral counseling.”

Disclosure: See the study for a full list of relevant disclosures.