Adherence to lifestyle changes in patients with Non-Alcoholic Fatty Liver Disease (NAFLD)
22 Mar 2022
Non-Alcoholic Fatty Liver Disease (NAFLD) is nowadays the most common cause of liver disease in Western countries [Ref 1]. Despite its increasing prevalence, however, treatment is currently limited to lifestyle intervention. In fact, many drugs are currently under development for this disease, with promising results in terms of inflammation reduction and fibrosis improvement, but none of them is already on the market [Ref 2]. Therefore, at the moment the only suggestions patients with NAFLD can receive are about dietary intervention and physical activity. It is important to state that weight loss is not a cosmetic result, since it has been shown to be responsible for improving the degree of fibrosis in these patients [Ref 3]. Therefore, it is essential to ensure that the patient maintains excellent compliance with the necessary lifestyle changes. In this sense, many programs were established to promote lifestyle intervention in these patients, but they often proved to be expensive and unsustainable [Ref 4]. In an effort to promote support for NAFLD patients, a virtual forum, Carenity, has been created, where patients can share their experiences related to NAFLD and other chronic diseases. A survey on the awareness of patients with NAFLD was launched on this platform, which yielded interesting results that were recently published by Carrieri et al.
In this study, 1411 patients with NAFLD/NASH were invited to answer a survey that was aimed to understand the perception of the patients about their disease. Interestingly, 75.3% of NAFLD/NASH patients perceived themselves as being in an early fibrosis stage independently from the actual stage of the disease. Moreover, 59.2% of all patients did not know their fibrosis stage, 34.4% were non-adherent to lifestyle changes and 14.0% were not concerned by the notion of the disease. Only 14.0% of the patients reported a good understanding about NAFLD/NASH progression. Patients who were aware of their fibrosis stage were more likely to have discussed their liver tests with their physician in the last year, to have received more information from different healthcare providers and to have been diagnosed between 1 and 5 years before the survey. People with severe obesity (BMI ≥35) were over two times more likely not to know their liver fibrosis status. Moreover, knowledge of their grade of fibrosis was negatively associated with the number of comorbidities, the area of residence and the ability to share the burden of the disease with others (family, friends, other people). Considering adherence to lifestyle intervention, lack of knowledge about fibrosis stage, female gender, obesity and scarce social resources were associated with an insufficient adherence to the changes that are needed to manage NAFLD [Ref 5]. This study showed us some very important considerations to keep in mind when managing a patient with NAFLD. In this sense, it is essential to ensure that the patient has a complete understanding of the disease and the support needed to maintain a new lifestyle, often difficult to follow. In particular, obese patients represent a category of people that need to be monitored very carefully, because they are more at risk of minimizing the disease and of being less adherent to the changes necessary for the control of fibrosis. In this sense, training for healthcare professionals and educational programs to support behavioral changes should be urgently and largely promoted.
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- Carrieri P, Mourad A, Marcellin F et al. Knowledge of liver fibrosis stage among adults with NAFLD/NASH improves adherence to lifestyle changes. Liver Int. 2022 Feb 26. doi: 10.1111/liv.15209. Epub ahead of print. PMID: 35220673.