Long‐term follow‐up of web‐based and group‐based behavioural intervention in NAFLD in a real world clinical setting

Abstract

SummaryBackgroundThe long‐term results of web‐based behavioural intervention in non‐alcoholic fatty liver disease (NAFLD) have not been described in patients followed in specialised centres.AimsTo analyse the long‐term effectiveness of web education compared with the results achieved by a group‐based behavioural intervention in the same years 2012–2014.MethodsWe followed 679 patients with NAFLD (web‐based, n = 290; group‐based, n = 389) for 5 years. Weight loss ≥10% was the primary outcome; secondary outcomes were attrition, changes in liver enzymes and in biomarkers of steatosis (Fatty liver Index) and fibrosis (Fibrosis‐4 index).ResultsThe cohorts differed in age, education, working status and presence of diabetes. Attrition was higher in the web‐based cohort (hazard ratio: 1.53; 95% CI: 1.24–1.88), but not different after adjustment for confounders. Among patients in active follow‐up, 50% lost ≥5% of initial body weight and 19% lost ≥10%, without difference between cohorts. Alanine aminotransferase levels fell to within the normal range in 51% and 45% of web‐ and group‐based cohorts, respectively. Fatty Liver Index declined progressively and, by year 5, it ruled out steatosis in 4.8%, whereas 24.9% were in the indeterminate range. Fibrosis‐4 index increased in both cohorts, driven by age, but the prevalence of cases ruling‐in advanced fibrosis remained very low (around 1%). Improvements in the class of both surrogate biomarkers were associated with ≥5% weight loss.ConclusionsAlthough burdened by attrition, web‐based behavioural intervention is feasible and effective in NAFLD, expanding the cohort involved in behavioural programs and reducing the risk of progressive disease.