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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2018/11  
 
  2018 Nov;69(5):1155-1163.  
  doi: 10.1016/j.jhep.2018.07.013.  
 
  An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers.  
 
  Mazzotti A, Caletti MT, Brodosi L, Di Domizio S, Forchielli ML, Petta S, Bugianesi E, Bianchi G, Marchesini G  
  https://www.ncbi.nlm.nih.gov/pubmed/30290973  
 
 

Abstract

BACKGROUND & AIMS:

Interventions aimed at lifestyle changes are pivotal for the treatment of non-alcoholic fatty liver disease (NAFLD), and web-based programs might help remove barriers in both patients and therapists.

METHODS:

In the period 2010-15, 716 consecutive NAFLD cases (mean age, 52; type 2 diabetes, 33%) were treated in our Department with structured programs. The usual protocol included motivational interviewing and a group-based intervention (GBI), chaired by physicians, dietitians and psychologists (five weekly meetings, n = 438). Individuals who could not attend GBI entered a web-based intervention (WBI, n = 278) derived from GBI, with interactive games, learning tests, motivational tests, and mail contacts with the center. The primary outcome was weight loss ≥10%; secondary outcomes were alanine aminotransferase within normal limits, changes in lifestyle, weight, alanine aminotransferase, and surrogate markers of steatosis and fibrosis.

RESULTS:

GBI and WBI cohorts had similar body mass index (mean, 33 kg/m2), with more males (67% vs. 45%), younger age, higher education, and more physical activity in the WBI group. The two-year attrition rate was higher in the WBI group. Healthy lifestyle changes were observed in both groups and body mass index decreased by almost two points;the 10% weight target was reached in 20% of WBI cases vs. 15% in GBI (not significant). In logistic regression analysis, after adjustment for confounders and attrition rates, WBI was not associated with a reduction of patients reaching short- and long-term 10% weight targets. Liver enzymes decreased in both groups, and normalized more frequently in WBI. Fatty liver index was reduced, whereas fibrosis remained stable (NAFLD fibrosis score) or similarly decreased (Fib-4).

CONCLUSION:

WBI is not less effective than common lifestyle programs, as measured by significant clinical outcomes associated with improved histological outcomes in NAFLD. eHealth programs may effectively contribute to NAFLD control.

LAY SUMMARY:

In patients with non-alcoholic fatty liver disease, participation in structured lifestyle programs may be jeopardized by job and time constraints. A web-based intervention may be better suited for young, busy patients, and for those living far from liver units. The study shows that, following a structured motivational approach, a web-based, interactive intervention coupled with six-month face-to-face meetings is not inferior to a standard group-based intervention with respect to weight loss, adherence to healthy diet and habitual physical activity, normalization of liver enzymes, and stable surrogate markers of fibrosis.

  
Question posée
 
Une approche basée sur Internet pour les changements de mode de vie chez les patients NAFLD : effets de deux ans sur la perte de poids et les marqueurs de substitution.
  
Question posée
 
L’approche basée sur un accompagnement en ligne n'est pas moins efficace que les programmes de suivi avec un contact physique direct. Les auteurs concluent que les programmes de santé en ligne peuvent contribuer efficacement au contrôle des NAFLD.
  
Commentaires

Chez les patients atteints de stéatose hépatique non alcoolique, la participation à des programmes de vie organisés afin de prendre en charge leur pathologie peut être compromise par des contraintes d’emploi et de temps. Une intervention utilisant Internet conviendrait peut-être mieux aux patients jeunes, occupés et à ceux vivant loin des unités hépatiques. L’étude montre que, suivant une approche motivationnelle structurée, une intervention interactive en ligne associée à des réunions en face-à-face, d’une durée de six mois, n’est pas inférieure à une intervention standard basée sur la participation à un groupe en ce qui concerne la perte de poids, l’adhésion à un régime alimentaire sain, la pratique d’une activité physique, la normalisation des enzymes hépatiques et l’amélioration des marqueurs de la fibrose.
 
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