Introduction
Metabolic-associated fatty liver disease (MAFLD) requires complex treatment based on diet and lifestyle. The understanding of the disease by patients through medical education is an element that could bring them a therapeutic benefit. Since the process is time-consuming and medical factors all over the world are under pressure to use maximum time for diagnostic and therapeutic purposes, an important role can be played by the voluntary activity carried out by medical students, under the guidance of teaching staff, devoted to this purpose.
Aims & Methods
A group of 250 patients with MAFLD, non-cirrhotic, diagnosed in a gastroenterology outpatient clinic, were proposed to participate in an educational program consisting of 3 sessions of 2 hours of interactive course about MAFLD (including notions of anatomy, physiology, diagnosis, evolution, prognosis, complications, risks, treatment, follow-up) in order to appreciate the contribution of medical education to the effectiveness of treatment. The patients did not receive medication but only recommendations regarding lifestyle changes and the Mediterranean diet. They were re-evaluated 6 months after the initial evaluation.
Results
Of the 250 patients, only 126 (50.4%) accepted participation in the educational plan after informed consent, a disappointing proportion; the subgroup of those who did not participate in the course was reported as a control group (the main reason of non-participation was the fact that most of these patients considered to have already enough knowledge about MAFLD), being also invited to be evaluate after 6 months. Educational presentations were given by medical students under the guidance of teaching staff (power-point presentations and informative flyers designed to fix the knowledges about disease) and patients were clinically, laboratory, ultrasound and fibroscan evaluated by attending physicians. Also a questionnaire about quality of life was completed by each patient. Finally, after 6 months, only 85 patients from the control group and 118 from the study group returned for the final evaluation. The final evaluation focused on 4 elements: 1- changes in body mass (decrease of more than 7%), 2- liver ultrasonography (reduction of the degree of steatosis), 3- laboratory analyzes (liver and metabolic tests) and 4- quality of life. In the study group, significantly better results were obtained for parameters 1, 3 and 4: (78%, 87.2%, 84.7%) compared to the reference group (38.8%, 54.1%, 62.3%) which confirms the fact that patient education is an important element in understanding the disease and its treatment. Only in parameter 2 (decrease of steatosis at ultrasonography) there were no significant differences between the two groups (50.8% vs 48.2%), probably due to the too short follow-up time of the patients.
Conclusion
Therapeutic education of patients with MAFLD can bring more efficiency to the treatment of the disease in non-cirrhotic patients, mainly on body mass control, liver laboratory tests and quality of life, if they accept to participate at educational program.
References
Koutny F, Aigner E, Datz C, Gensluckner S, Maieron A, Mega A, Iglseder B, Langthaler P, Frey V, Paulweber B, Trinka E, Wernly B. Relationships between education and non-alcoholic fatty liver disease. Eur J Intern Med. 2023 Dec;118:98-107. doi: 10.1016/j.ejim.2023.07.039. Epub 2023 Aug 3. PMID: 37541922.
Lee WM, Bae JH, Chang Y, Lee SH, Moon JE, Jeong SW, Jang JY, Kim SG, Kim HS, Yoo JJ, Kim YS. Effect of Nutrition Education in NAFLD Patients Undergoing Simultaneous Hyperlipidemia Pharmacotherapy: A Randomized Controlled Trial. Nutrients. 2021 Dec 13;13(12):4453. doi: 10.3390/nu13124453. PMID: 34960005; PMCID: PMC8709046.