Introduction
Metabolic dysfunction-associated Steatotic Liver disease (MASLD) is complicated by various cardiometabolic (CMR) manifestations, and the prognosis is severely burdened by acute cardiovascular events (ACE).
Even though several drugs have been tested to target CMR comorbidities, lifestyle modifications remain the cornerstone intervention. Unfortunately, the dietary-behavioral prescription is constantly limited by poor compliance, with the sociodemographic-determinant factors impacting this remaining undetermined.
Moreover, despite emerging evidence supporting behavioral therapy's relevance, the real long-term benefits of offering motivational support to MASLD individuals represent an unexplored scenario in real life.
Aims & Methods
This study aimed to evaluate the efficacy of multidisciplinary management on clinical outcomes in MASLD, investigating compliance with specialist-tailored indications. We consecutively enrolled individuals presenting MASLD diagnostic criteria (n.286). After recruitment, patients were randomized into three cohorts: subjects (n.72) receiving generic hepatologist-provided advice (“H”); subjects (n.71) also receiving the nutritionists-prescribed individualized intervention (“HN”); patients (n.143) treated with an approach additionally involving cognitive/behavioral-based psychological support (“HNP”). H and HN represented the “standard of care” (n.143), whereas “HNP” constituted the “experimental group” (n.143). At baseline, anthropometric, biochemical, clinical, liver stiffness (LSM), controlled attenuation parameter (CAP), lifestyle habits (including sociodemographic determinants), and body composition values were recorded. Along 24 months, on semestral hepatological, nutritional (H and HN), and psychological (HNP) follow-ups, all parameters were reassessed, the occurrence of ACEs was recorded, and compliance was opportunely evaluated. Three time-study points were considered: baseline (T0), intermediate (i.e., after 18 months – T1), and end of the study (T2).
Results
Intermediate evaluations revealed a significantly higher prevalence of individuals achieving a >10% decrease in body weight (HNP:62.09%; HN:44.9%; H:35.8%; chi-square, HNP vs. HN, p:0.01; HNP vs. H, p:0.0002) after 18 months (T1) in the experimental group. At the end of the observation period (T2), in this setting, a further increase in the proportion of individuals presenting and preserving >10% decrease in body weight was reported (HNP: 72.03%; HN: 46.7%; H: 39.2%, chi-square T1, HNP vs. HN, p:0.02; HNP vs. H, p:0.0001; McNemar T1-T2 HNP vs HN, p:0.001, HNP vs H, p:0.001), as wells as a significant improvement in Homeostatic-model-assessment-for-insulin-resistance (p:0.001), HDL (p < 0.0001), LSM (p:0.007), CAP (p:0.002), and fat-mass (p < 0.0001) was observed (HNP, T0 vs T2).
Relevantly, HNP patients presented a significantly lower risk of ACEs [HR: 0.497, IC (0.236-0.751) 95%, p:0.04)]. Logistic regression analysis (adjusted for sex, age, drug administration, and cardiovascular risk factors) revealed that HNP adherence was significantly associated with lower ACE occurrence (aOR: 0.81; C.I. 95%: 0.55-0.97; p:0.02). Consistently, the loss of compliance rate was significantly lower in HNP (HNP:12.08%; HN:34.7%; H:45.8%; HNP vs HN, HNP vs H, p:0.001). Finally, the analysis of sociodemographic factors revealed large family (i.e., > 3 individuals), dynamic work (i.e., < 2 hours/die dedicated to main meals), and city life as social determinants impacting compliance (OR: 2.11, 1.78, 1.12) (all p < 0.05).
Conclusion
In the era of Precision Medicine, the correct management of MASLD patients should contemplate the integration of standard hepatological-nutritional with psychological support.
References
- Romeo M, Dallio M, Cipullo M, Coppola A, Mazzarella C, Mammone S, Iadanza G, Napolitano C, Vaia P, Ventriglia L, Federico A. Nutritional and Psychological Support as a Multidisciplinary Coordinated Approach in the Management of Chronic Liver Disease: A Scoping Review. Nutr Rev. 2025 Feb 24:nuaf001. doi: 10.1093/nutrit/nuaf001. Epub ahead of print. PMID: 39992295.
- Righetti R, Cinque F, Volpe MT, Sebastiani G. Integrating behavioral interventions into a holistic approach to metabolic dysfunction-associated steatotic liver disease. Expert Rev Gastroenterol Hepatol. 2024 Jul;18(7):303-313. doi: 10.1080/17474124.2024.2385487. Epub 2024 Aug 5. PMID: 39075881.
- European Association for the Study of the Liver (EASL) Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024 Sep;81(3):492-542. doi: 10.1016/j.jhep.2024.04.031. Epub 2024 Jun 7. PMID: 38851997.