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Web-based lifestyle intervention as effective as group programs for fatty liver

PARIS — A web-based lifestyle counselling program for patients with nonalcoholic fatty liver disease demonstrated long-term efficacy and non-inferiority compared with group-based lifestyle counselling, according to a presentation at the International Liver Congress 2018.

“Following a structured motivational approach, a web-based interactive intervention, coupled with face-to-face meetings at 6-month intervals, is not less effective than usual lifestyle programs in achieving weight loss, adherence to healthy diet and habitual physical activity, normalization of liver enzymes, without deterioration of surrogate outcomes of fibrosis,” Giulio Marchesini, MD, from the University of Bologna in Italy, said in his presentation.

Between 2010 and 2015, Marchesini and colleagues observed 716 patients recently diagnosed with NAFLD who enrolled in a 5-week group-based lifestyle modification program, of whom 438 completed the program.

The researchers also developed a web-based intervention for the 278 patients who could not join the group-based program due to logistics, work-related complications, or time constraints. The web-based intervention included five modules, interactive games, off-line contact with the institution, and questionnaires to investigate motivation and competence.

During follow-up, patients were treated for comorbidities and markers of severity were tested, but patients did not receive therapy for liver disease.

In the web-based intervention, the researchers observed higher attrition (OR = 2.46; 95% CI, 1.68-3.61), which correlated with female sex, normal alanine aminotransferase levels and absence of diabetes.

BMI decreased in both groups by nearly 2 points. In the web-based intervention, 14% of patients achieved the 10% weight loss target and another 20% to 28% achieved a 5% weight loss. Patients in the web-based intervention were also more likely to achieve normalized ALT than the group-based program (27% vs. 13% to 17%), which increased at 6 months (OR = 2.34; 95% CI, 1.27-4.3) and 12 months (OR = 1.62; 95% CI, 0.94-2.78).

“Weight loss has long been recognized as an effective therapy for NAFLD, but the challenge has been creating the infrastructure to achieve it,” Phil Newsome, PhD, from the Queen Elizabeth Hospital and University of Birmingham, United Kingdom, and EASL Governing Board Member, said in a press release. “Most studies have used conventional resource-intensive regimens which are not widely available in most clinical practices. This study by Prof. Marchesini demonstrates the potential of web-based approaches to achieve this at scale. The challenge now will be to see if patients are able to sustain the weight loss for longer periods of time.” – by Talitha Bennett

For more information:

Mazzotti A, et al. PS-112. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.

Disclosure: The authors report no relevant financial disclosures.