Behavioral weight-loss interventions for patients with NAFLD: A systematic scoping review Hepatology Communications
Abstract Background: Clinically significant weight loss—which requires sustained dietary and physical activity changes—is central to treating NAFLD. Although behavioral interventions have demonstrated effectiveness in promoting weight loss among primary prevention populations, the data are limited among patients with NAFLD who need weight loss for treatment. We undertook this scoping review to map the existing data on the characteristics, weight-loss outcomes, and determinants of success of interventions evaluated among patients with NAFLD. Methods: We searched Medline, EMBASE, Cochrane, PsycINFO, and Web of Science from inception to January 1, 2023 to identify publications reporting weight loss among adults with NAFLD in behavioral weight-loss interventions. We summarized interventions and classified them as successful if there was an average weight loss of ≥ 5% from baseline across enrolled participants or achieved by ≥ 50% of enrolled participants. Results: We included 28 studies: 10 randomized control trials, ten quasi-experimental, and 8 observational studies. Intervention delivery, duration, and counseling frequency varied; 12 were successful. Retention was highest among telephone interventions and lowest among “real-world” face-to-face interventions. Patients who were women, younger, and/or had multiple metabolic conditions were most likely to dropout. Successful interventions had biweekly counseling, specific physical activity, and calorie targets, behavioral theory grounding, and promoted goal-setting, self-monitoring, and problem-solving. Conclusion: There are limited data on behavioral weight-loss interventions in NAFLD. Research is needed to develop effective interventions generalizable to diverse patient populations and that maximize adherence, particularly among patients who are diabetic, women, and younger.
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Maya Balakrishnan, Kyle Liu, Sydney Schmitt et al.. Behavioral weight-loss interventions for patients with NAFLD: A systematic scoping review. Hepatology Communications. (2023). https://doi.org/10.1097/HC9.0000000000000224 Maya Balakrishnan, Kyle Liu, Sydney Schmitt, Natalia I Heredia, Amy Sisson, Jane R Montealegre, Ruben Hernaez, Fasiha Kanwal, John Foreyt
1Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA 2Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA 3Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA 4Houston Academy of Medicine Texas Medical Center Library, Houston, Texas, USA 5Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA 6Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA 7Division of General Internal Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA 