Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2024; 30(10): 1393-1404
Published online Mar 14, 2024. doi: 10.3748/wjg.v30.i10.1393
Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease
Ming-Hui Zeng, Qi-Yu Shi, Liang Xu, Yu-Qiang Mi
Ming-Hui Zeng, Liang Xu, Yu-Qiang Mi, Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin 300192, China
Qi-Yu Shi, Department of Gastroenterology, Cangzhou People’s Hospital, Cangzhou 061000, Hebei Province, China
Liang Xu, Yu-Qiang Mi, Department of Hepatology, Tianjin Second People’s Hospital, Tianjin 300192, China
Liang Xu, Yu-Qiang Mi, Tianjin Research Institute of Liver Diseases, Tianjin 300192, China
Co-first authors: Ming-Hui Zeng and Qi-Yu Shi.
Co-corresponding authors: Liang Xu and Yu-Qiang Mi.
Author contributions: Zeng MH and Shi QY contributed equally to this work as co-first authors; Mi YQ and Xu L conceptualized and designed the study; Shi QY participated in the acquisition, analysis, interpretation of the data, and drafting of the manuscript; Zeng MH participated in the acquisition and analysis of the data, and editing of the manuscript.
Supported by the Science and Technology Foundation of Tianjin Municipal Health Bureau, No. 12KG119; Tianjin Key Medical Discipline (Specialty) Construction Project, No. TJYXZDXK-059B; Tianjin Health Science and Technology Project key discipline special, No. TJWJ2022XK034; and Research project of Chinese traditional medicine and Chinese traditional medicine combined with Western medicine of Tianjin municipal health and Family Planning Commission, No. 2021022.
Institutional review board statement: This study has been reviewed and approved by the Ethics Committee of Tianjin Second People’s Hospital [approved No. (2012)06].
Clinical trial registration statement: This study is registered at (https://www.chictr.org.cn/showproj.html?proj=5809). The registration identification number is (ChiCTR-ONRC-13003751).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There are no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Qiang Mi, MD, Chief Doctor, Professor, Department of Hepatology, Tianjin Second People’s Hospital, Clinical School of the Second People’s Hospital, Tianjin Medical University, No. 7 Sudi South Road, Nankai District, Tianjin 300192, China. yuqiangmi68@163.com
Received: December 24, 2023
Peer-review started: December 24, 2023
First decision: January 4, 2024
Revised: January 16, 2024
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 14, 2024
Processing time: 81 Days and 8.7 Hours
Abstract
BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, affecting about 1/4th of the global population and causing a huge global economic burden. To date, no drugs have been approved for the treatment of NAFLD, making the correction of unhealthy lifestyles the principle method of treatment. Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important.

AIM

To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions.

METHODS

The Exercise and Diet Adherence Scale (EDAS) was designed based on compilation using the Delphi method, and its reliability was subsequently evaluated. Demographic and laboratory indicators were measured, and patients completed the EDAS questionnaire at baseline and after 6 months. The efficacy of the EDAS was evaluated in the initial cohort. Subsequently, the efficacy of the EDAS was internally verified in a validation cohort.

RESULTS

The EDAS consisted of 33 items in six dimensions, with a total of 165 points. Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake (P < 0.05 each), but not with overall weight loss. A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake (> 500 kacl/d), (sensitivity/specificity was 100.0%/75.8%), while patients score below 97 could nearly rule out the possibility of daily exercise (sensitivity/specificity was 89.5%/44.4%). Total EDAS scores ≥ 116, 97-115, and < 97 points were indicative of good, average, and poor adherence, respectively, to diet and exercise recommendations.

CONCLUSION

The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.

Keywords: Fatty liver, Lifestyle intervention, Behavioral change, Patient adherence, Compliance

Core Tip: This study developed and validated an Exercise and Diet Adherence Scale (EDAS) to rapidly assess adherence to lifestyle interventions in patients with non-alcoholic fatty liver disease (NAFLD). Patients can be grouped based on their EDAS scores and receive personalized treatments accordingly. The EDAS demonstrated reliability and effectiveness in predicting adherence to lifestyle changes and served as a vital tool in the clinical management of patients with NAFLD.