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
ARTICLE HIGHLIGHTS
Research background

Non-alcoholic fatty liver disease (NAFLD) is a progressive disease that can lead to complications such as liver fibrosis, cirrhosis, hepatocellular carcinoma, cardiovascular diseases, and metabolic disorders such as type 2 diabetes. However, to date, no medications have been approved for treating NAFLD, and lifestyle modifications remain the cornerstone of treatment.

Research motivation

Changing an unhealthy lifestyle can be useful for alleviating hepatic steatosis in patients with NAFLD. However, not everyone is able or willing to adhere to the dietary and exercise guidelines. The variety of exercise and dietary controls makes it challenging to quantify and evaluate patient’s adherence.

Research objectives

To evaluate adherence effectively and swiftly with the recommendations for lifestyle changes in patients with NAFLD, implementing various intervention strategies based on adherence levels to prevent disease progression is crucial.

Research methods

First, we identified factors affecting exercise and dietary adherence in patients with NAFLD. The Delphi method was used to analyze and modify the Exercise and Diet Adherence Scale (EDAS). After a preliminary small-scale survey and further adjustments, the EDAS was established. Enrolled patients with NAFLD followed exercise and diet interventions, filled the EDAS at the beginning, and were followed up for 6 months. Finally, we evaluated and validated the reliability of the EDAS.

Research results

The EDAS demonstrated good item discrimination; internal consistency reliability; test-retest reliability; and content, construct, and criterion validity. It can reliably measure the adherence of patients with NAFLD to exercise and dietary interventions.

Research conclusions

The EDAS has been established to assess the adherence of patients objectively, directly, and rapidly with NAFLD to changing unhealthy lifestyles. This reliable tool supports early intervention in NAFLD, aims to prevent disease progression, and reduces the healthcare burden.

Research perspectives

EDAS plays an important clinical role in the assessment, treatment, and management of NAFLD. However, its widespread application requires multicenter prospective studies. Additionally, the participants in this study did not undergo a liver biopsy. Thus, future research should explore the impact of EDAS on liver pathology.