Weight Loss in Nonalcoholic Fatty Liver Disease Patients in an Ambulatory Care Setting Is Largely Unsuccessful but Correlates with Frequency of Clinic Visits
Identifieur interne : 000829 ( Main/Exploration ); précédent : 000828; suivant : 000830Weight Loss in Nonalcoholic Fatty Liver Disease Patients in an Ambulatory Care Setting Is Largely Unsuccessful but Correlates with Frequency of Clinic Visits
Auteurs : Anwar Dudekula [États-Unis] ; Vikrant Rachakonda [États-Unis] ; Beebijan Shaik [États-Unis] ; Jaideep Behari [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Descripteurs français
- KwdFr :
- MESH :
English descriptors
- KwdEn :
- MESH :
- complications : Obesity.
- epidemiology : Non-alcoholic Fatty Liver Disease, Obesity.
- Adult, Ambulatory Care, Body Mass Index, Humans, Logistic Models, Male, Middle Aged, Overweight, Retrospective Studies, Weight Loss.
Abstract
Nonalcoholic fatty liver disease (NALFD) is a leading cause of liver disease. Weight loss improves clinical features of NAFLD; however, maintenance of weight loss outside of investigational protocols is poor. The goals of this study were to characterize patterns and clinical predictors of long-term weight loss in ambulatory patients with NAFLD.
We retrospectively reviewed 924 non-cirrhotic patients with NAFLD presenting to a liver clinic from May 1st 2007 to April 30th 2013. Overweight and obese patients were counseled on lifestyle modifications for weight loss as per USPSTF guidelines. The primary outcome was percent weight change between the first and last recorded visits: % weight change = (weightinitial – weightfinal)/(weightinitial). Baseline BMI and percent BMI change were secondary measures. Predictors of weight loss were determined using logistic regression.
The mean baseline BMI was 33.3±6.6 kg/m2, and the mean follow-up duration was 17.3±17.6 months. Most patients with NAFLD were in either overweight (26.1%) or class I obesity (30.5%) categories at baseline, while the prevalence of underweight and class III obesity was lower (0.2% and 15.4%, respectively). Overall, there was no change in mean weight or BMI during the follow-up period, and only 183 patients (19.8%) lost at least 5% body weight during the follow up period. Independent predictors of weight loss included number of clinic visits and baseline BMI, and patients with higher baseline BMI required more clinic visits to lose weight.
Weight loss is largely unsuccessful in NAFLD patients in the ambulatory care setting. Frequent clinical encounters are associated with weight reduction, especially among individuals with high baseline BMI. Future studies are required to define effective weight loss strategies in NAFLD patients.
Url:
DOI: 10.1371/journal.pone.0111808
PubMed: 25375228
PubMed Central: 4222918
Affiliations:
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last="Dudekula">Anwar Dudekula</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Rachakonda, Vikrant" sort="Rachakonda, Vikrant" uniqKey="Rachakonda V" first="Vikrant" last="Rachakonda">Vikrant Rachakonda</name><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Shaik, Beebijan" sort="Shaik, Beebijan" uniqKey="Shaik B" first="Beebijan" last="Shaik">Beebijan Shaik</name><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Behari, Jaideep" sort="Behari, Jaideep" uniqKey="Behari J" first="Jaideep" last="Behari">Jaideep Behari</name><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Ambulatory Care</term><term>Body Mass Index</term><term>Humans</term><term>Logistic Models</term><term>Male</term><term>Middle Aged</term><term>Non-alcoholic Fatty Liver Disease (epidemiology)</term><term>Obesity (complications)</term><term>Obesity (epidemiology)</term><term>Overweight</term><term>Retrospective Studies</term><term>Weight Loss</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Humains</term><term>Indice de masse corporelle</term><term>Modèles logistiques</term><term>Mâle</term><term>Obésité ()</term><term>Obésité (épidémiologie)</term><term>Perte de poids</term><term>Soins ambulatoires</term><term>Stéatose hépatique non alcoolique (épidémiologie)</term><term>Surpoids</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Obesity</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Non-alcoholic Fatty Liver Disease</term><term>Obesity</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Obésité</term><term>Stéatose hépatique non alcoolique</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Ambulatory Care</term><term>Body Mass Index</term><term>Humans</term><term>Logistic Models</term><term>Male</term><term>Middle Aged</term><term>Overweight</term><term>Retrospective Studies</term><term>Weight Loss</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Humains</term><term>Indice de masse corporelle</term><term>Modèles logistiques</term><term>Mâle</term><term>Obésité</term><term>Perte de poids</term><term>Soins ambulatoires</term><term>Surpoids</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background and Aims</title><p>Nonalcoholic fatty liver disease (NALFD) is a leading cause of liver disease. Weight loss improves clinical features of NAFLD; however, maintenance of weight loss outside of investigational protocols is poor. The goals of this study were to characterize patterns and clinical predictors of long-term weight loss in ambulatory patients with NAFLD.</p></sec><sec><title>Methods</title><p>We retrospectively reviewed 924 non-cirrhotic patients with NAFLD presenting to a liver clinic from May 1<sup>st</sup> 2007 to April 30<sup>th</sup> 2013. Overweight and obese patients were counseled on lifestyle modifications for weight loss as per USPSTF guidelines. The primary outcome was percent weight change between the first and last recorded visits: % weight change = (weight<sup>initial</sup> – weight<sup>final</sup>)/(weight<sup>initial</sup>). Baseline BMI and percent BMI change were secondary measures. Predictors of weight loss were determined using logistic regression.</p></sec><sec><title>Results</title><p>The mean baseline BMI was 33.3±6.6 kg/m<sup>2</sup>, and the mean follow-up duration was 17.3±17.6 months. Most patients with NAFLD were in either overweight (26.1%) or class I obesity (30.5%) categories at baseline, while the prevalence of underweight and class III obesity was lower (0.2% and 15.4%, respectively). Overall, there was no change in mean weight or BMI during the follow-up period, and only 183 patients (19.8%) lost at least 5% body weight during the follow up period. Independent predictors of weight loss included number of clinic visits and baseline BMI, and patients with higher baseline BMI required more clinic visits to lose weight.</p></sec><sec><title>Conclusions</title><p>Weight loss is largely unsuccessful in NAFLD patients in the ambulatory care setting. Frequent clinical encounters are associated with weight reduction, especially among individuals with high baseline BMI. Future studies are required to define effective weight loss strategies in NAFLD patients.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Targher, G" uniqKey="Targher G">G Targher</name></author><author><name sortKey="Day, Cp" uniqKey="Day C">CP Day</name></author><author><name sortKey="Bonora, E" uniqKey="Bonora E">E Bonora</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vernon, G" uniqKey="Vernon G">G Vernon</name></author><author><name sortKey="Baranova, A" uniqKey="Baranova A">A Baranova</name></author><author><name sortKey="Younossi, Zm" uniqKey="Younossi Z">ZM Younossi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Williams, Cd" uniqKey="Williams C">CD Williams</name></author><author><name sortKey="Stengel, J" uniqKey="Stengel J">J Stengel</name></author><author><name sortKey="Asike, Mi" uniqKey="Asike M">MI Asike</name></author><author><name 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Tate</name></author><author><name sortKey="Gorin, Aa" uniqKey="Gorin A">AA Gorin</name></author><author><name sortKey="Raynor, Ha" uniqKey="Raynor H">HA Raynor</name></author><author><name sortKey="Fava, Jl" uniqKey="Fava J">JL Fava</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Svetkey, Lp" uniqKey="Svetkey L">LP Svetkey</name></author><author><name sortKey="Stevens, Vj" uniqKey="Stevens V">VJ Stevens</name></author><author><name sortKey="Brantley, Pj" uniqKey="Brantley P">PJ Brantley</name></author><author><name sortKey="Appel, Lj" uniqKey="Appel L">LJ Appel</name></author><author><name sortKey="Hollis, Jf" uniqKey="Hollis J">JF Hollis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haufe, S" uniqKey="Haufe S">S Haufe</name></author><author><name sortKey="Haas, V" uniqKey="Haas V">V Haas</name></author><author><name sortKey="Utz, W" uniqKey="Utz W">W Utz</name></author><author><name sortKey="Birkenfeld, Al" uniqKey="Birkenfeld A">AL Birkenfeld</name></author><author><name sortKey="Jeran, S" uniqKey="Jeran S">S Jeran</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Perseghin, G" uniqKey="Perseghin G">G Perseghin</name></author><author><name sortKey="Lattuada, G" uniqKey="Lattuada G">G Lattuada</name></author><author><name sortKey="De Cobelli, F" uniqKey="De Cobelli F">F De Cobelli</name></author><author><name sortKey="Ragogna, F" uniqKey="Ragogna F">F Ragogna</name></author><author><name sortKey="Ntali, G" uniqKey="Ntali G">G Ntali</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Na" uniqKey="Johnson N">NA Johnson</name></author><author><name sortKey="Sachinwalla, T" uniqKey="Sachinwalla T">T Sachinwalla</name></author><author><name sortKey="Walton, Dw" uniqKey="Walton D">DW Walton</name></author><author><name sortKey="Smith, K" uniqKey="Smith K">K Smith</name></author><author><name sortKey="Armstrong, A" uniqKey="Armstrong A">A Armstrong</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Pennsylvanie</li></region></list><tree><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Dudekula, Anwar" sort="Dudekula, Anwar" uniqKey="Dudekula A" first="Anwar" last="Dudekula">Anwar Dudekula</name></region><name sortKey="Behari, Jaideep" sort="Behari, Jaideep" uniqKey="Behari J" first="Jaideep" last="Behari">Jaideep Behari</name><name sortKey="Rachakonda, Vikrant" sort="Rachakonda, Vikrant" uniqKey="Rachakonda V" first="Vikrant" last="Rachakonda">Vikrant Rachakonda</name><name sortKey="Shaik, Beebijan" sort="Shaik, Beebijan" uniqKey="Shaik B" first="Beebijan" last="Shaik">Beebijan Shaik</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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