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Petermann-Rocha F, Carrasco-Marin F, Boonpor J, Parra-Soto S, Shannon O, Malcomson F, Phillips N, Jain M, Deo S, Livingstone KM, Dingle SE, Mathers JC, Forrest E, Ho FK, Pell JP, Celis-Morales C. Association of five diet scores with severe NAFLD incidence: A prospective study from UK Biobank. Diabetes Obes Metab 2024; 26:860-870. [PMID: 37997550 DOI: 10.1111/dom.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023]
Abstract
AIM This study aimed to contrast the associations of five common diet scores with severe non-alcoholic fatty liver disease (NAFLD) incidence. MATERIALS AND METHODS In total, 162 999 UK Biobank participants were included in this prospective population-based study. Five international diet scores were included: the 14-Item Mediterranean Diet Adherence Screener (MEDAS-14), the Recommended Food Score (RFS), the Healthy Diet Indicator (HDI), the Mediterranean Diet Score and the Mediterranean-DASH Intervention for Neurodegenerative Delay score. As each score has different measurements and scales, all scores were standardized and categorized into quartiles. Cox proportional hazard models adjusted for confounder factors investigated associations between the standardized quartiles and severe NAFLD incidence. RESULTS Over a median follow-up of 10.2 years, 1370 participants were diagnosed with severe NAFLD. When the analyses were fully adjusted, participants in quartile 4 using the MEDAS-14 and RFS scores, as well as those in quartiles 2 and 3 using the HDI score, had a significantly lower risk of severe incident NAFLD compared with those in quartile 1. The lowest risk was observed in quartile 4 for the MEDAS-14 score [hazard ratio (HR): 0.76 (95% confidence interval (CI): 0.62-0.94)] and the RFS score [HR: 0.82 (95% CI: 0.69-0.96)] and as well as in quartile 2 in the HDI score [HR: 0.80 (95% CI: 0.70-0.91)]. CONCLUSION MEDAS-14, RFS and HDI scores were the strongest diet score predictors of severe NAFLD. A healthy diet might protect against NAFLD development irrespective of the specific approach used to assess diet. However, following these score recommendations could represent optimal dietary approaches to mitigate NAFLD risk.
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Affiliation(s)
- Fanny Petermann-Rocha
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Fernanda Carrasco-Marin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
| | - Jirapitcha Boonpor
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakon Nakhon Province Campus, Kasetsart University, Sakon Nakhon, Thailand
| | - Solange Parra-Soto
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Nutrition and Public Health, Universidad del Bío-Bío, Chillán, Chile
| | - Oliver Shannon
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Malcomson
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nathan Phillips
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Mahek Jain
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Salil Deo
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Case School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sara E Dingle
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ewan Forrest
- Department of Gastroenterology, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Human Performance Laboratory, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, Chile
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Damigou E, Faka A, Kouvari M, Anastasiou C, Kosti RI, Chalkias C, Panagiotakos D. Adherence to a Mediterranean type of diet in the world: a geographical analysis based on a systematic review of 57 studies with 1,125,560 participants. Int J Food Sci Nutr 2023; 74:799-813. [PMID: 37771002 DOI: 10.1080/09637486.2023.2262781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023]
Abstract
This systematic review aimed to assess the level and time-trends of adherence to Mediterranean-type diets (MTD) among the general population, globally. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a comprehensive literature search of the MEDLINE and Scopus databases was carried out, until 04/09/2023, based on specific criteria. Fifty-seven studies with 1,125,560 apparently healthy adults from Europe (n = 37), US (n = 8), Asia (n = 8), Australia (n = 4) and Africa (n = 1) were included. Adherence to an MTD was moderate with a significant decline observed in the last decade. European countries, mainly driven by Mediterranean countries, showed higher adherence than other regions. Geographical analysis revealed that adherence to an MTD is related to both geographic location and socioeconomic status throughout the world.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Antigoni Faka
- Department of Geography, School of Environmental Sciences, Harokopio University, Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Costas Anastasiou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Rena I Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly Trikala, Greece
| | - Christos Chalkias
- Department of Geography, School of Environmental Sciences, Harokopio University, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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Huang R, Fan JG, Shi JP, Mao YM, Wang BY, Zhao JM, Lu LG, Zhong BH, Zou ZS, Xu YQ, Ye YN, Liu L, Lin LJ, Rao H, Wei L. Stages of psychological change among patients with non-alcoholic fatty liver disease in China: a national cross-sectional study. BMJ Open 2023; 13:e062131. [PMID: 37339833 DOI: 10.1136/bmjopen-2022-062131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is becoming the leading cause of chronic liver disease worldwide. However, treatment of NAFLD is potentially influenced by psychological conditions. Using the simplified version of the University of Rhode Island Change Assessment (URICA-SV) scale, this study aimed to evaluate the stage of psychological change as a prerequisite to refining implementation strategies for psychological change. DESIGN A multicentre cross-sectional survey. SETTING Ninety hospitals in China. PARTICIPANTS 5181 patients with NAFLD were included in this study. OUTCOME MEASURES All patients completed the URICA-SV questionnaire and were assigned to one of the three stages of change (precontemplation, contemplation or action) according to their readiness scores. A stepwise multivariate logistic regression analysis was used to identify independent factors associated with the stage of psychological change. RESULTS A total of 4832 (93.3%) patients were included in the precontemplation stage and only 349 (6.7%) considered making a change or preparing to make one. There were significant differences in gender (Cohen's d=0.039, p=0.005), age (Cohen's d=-0.327, p<0.001), waist circumference (Cohen's d=0.143, p=0.003), alanine transaminase (Cohen's d=0.347, p=0.001), triglyceride (Cohen's d=0.351, p=0.002), body mass index (BMI; Cohen's d=0.056, p<0.001), proportion of hyperlipidaemia (Cohen's d=0.068, p<0.001) and cardiovascular disease (Cohen's d=0.032, p=0.029), therapeutic regimen (Cohen's d=0.136, p<0.001), and Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease overall score (Cohen's d=-0.420, p<0.001) between patients with NAFLD in the precontemplation stage and those in the contemplation/action stage. Logistic regression identified BMI (HR 0.659, 95% CI 0.469 to 0.928, p=0.017), cardiovascular disease (HR 2.161, 95% CI 1.089 to 4.287, p=0.027) and triglyceride (HR 0.751, 95% CI 0.591 to 0.955, p=0.020) as independent factors predicting psychological change. CONCLUSIONS The results demonstrated that very few patients with NAFLD presented psychological condition in the stage of action. Psychological condition was found to be significantly related to BMI, cardiovascular disease and triglyceride factors. Integrated diversity considerations for evaluating psychological change are necessary.
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Affiliation(s)
- Rui Huang
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Jian-Gao Fan
- Department of Hepatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun-Ping Shi
- Department of Hepatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yi-Min Mao
- Department of Digestive, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing-Yuan Wang
- Department of Digestive, The First Hospital of China Medical University, Shenyang, China
| | - Jing-Min Zhao
- Department of Pathology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Lun Gen Lu
- Department of Hepatology, The First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bi-Hui Zhong
- Department of Digestive, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Zheng-Sheng Zou
- Department of Pathology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - You-Qing Xu
- Department of Digestive, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Nong Ye
- Department of Infectious Disease, The First Hospital of Fushan, Fushan, China
| | - Longgen Liu
- Department of Hepatology, Third People's Hospital of Changzhou, Changzhou, China
| | - Lian-Jie Lin
- Department of Digestive, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huiying Rao
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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4
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Zheng J, Zhao L, Dong J, Chen H, Li D, Zhang X, Hassan MM, Steck SE, Li X, Xiang YB, Wang H. The role of dietary factors in nonalcoholic fatty liver disease to hepatocellular carcinoma progression: A systematic review. Clin Nutr 2022; 41:2295-2307. [PMID: 36096063 DOI: 10.1016/j.clnu.2022.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Dietary factors play an important role in promoting nonalcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) development through regulation of metabolism and inflammation. However, so far there was no evidence regarding how dietary factors may influence different disease outcomes in the NAFLD to HCC progression. Our study aimed to comprehensively evaluate the role of dietary factors on the risk of progression from NAFLD to HCC. METHODS A comprehensive literature research was conducted in PubMed, Web of Science and Embase databases to identify case-control and cohort studies published up to March 15, 2022 in English. We included studies investigating associations of food and beverage items (excluding alcohol), food groups, dietary patterns, and dietary habits with incidence risk of four main chronic liver diseases involved in the NAFLD-to-HCC progression (i.e., NAFLD, liver fibrosis, liver cirrhosis, and HCC). Three researchers independently performed the literature search, selected eligible articles, performed data abstraction and evaluated study quality. After evaluating adequacy and credibility of the associations reported for each dietary factor and each liver disease outcome, we summarized and evaluated the consistency of associations based on a priori determined criteria considering study design and the proportion of significant associations. RESULTS There were 109 studies included in this review (47 on NAFLD, 1 on liver fibrosis, 6 on liver cirrhosis, and 55 on HCC). Consistent evidence suggested that higher dietary inflammatory potential was associated with increased risk of both NAFLD and HCC whereas Mediterranean diet was associated with lower risk of both diseases. Additionally, greater conformity to the Healthy Eating Index, Dietary Approaches to Stop Hypertension score, and Mediterranean Diet Score, and dietary patterns with high dietary antioxidant capacity reduced NAFLD risk. Some specific foods including soft drinks and red and/or processed meat were associated with increased NAFLD risk while total vegetables and spinach were associated with reduced NAFLD risk. Coffee and white meat consumption were inversely related to HCC risk. CONCLUSIONS Dietary patterns or individual foods representing a more anti-inflammatory potential were associated with reduced risk of both NAFLD and HCC, which implied diet-induced inflammation may impact NAFLD progression towards HCC.
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Affiliation(s)
- Jiali Zheng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, No.227 South Chongqing Road, Rm 415, China
| | - Longgang Zhao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Jingwen Dong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, No.227 South Chongqing Road, Rm 415, China
| | - Huiyi Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, No.227 South Chongqing Road, Rm 415, China
| | - Donghui Li
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Manal M Hassan
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Xiaoguang Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, No.227 South Chongqing Road, Rm 415, China.
| | - Yong-Bing Xiang
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, No. 25, Lane 2200, Xie Tu Road, China.
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, No.227 South Chongqing Road, Rm 415, China.
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Association between Mediterranean Diet and Fatty Liver in Women with Overweight and Obesity. Nutrients 2022; 14:nu14183771. [PMID: 36145146 PMCID: PMC9501123 DOI: 10.3390/nu14183771] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Obesity is a risk factor for NAFLD. However, not all people with obesity have an excessive intrahepatic fat content. Adherence to a high-quality dietary pattern may also promote liver health in obesity. A cross-sectional study of 2967 women with overweight and obesity was carried out to assess the association between a Mediterranean diet and fatty liver. All women underwent clinical examination, anthropometric measurements, blood sampling, ultrasound measurements of abdominal visceral and subcutaneous fat, and assessment of adherence to the Mediterranean diet using the 14-item MEDAS questionnaire. Fatty liver index (FLI), NAFLD fatty liver steatosis (NAFLD-FLS) and hepatic steatosis index (HSI) were calculated. In women with obesity, the MEDAS score was inversely associated with FLI (β = −0.60, 95% CI: −1.04, −0.16, p = 0.008), NAFLD-FLS (β = −0.092, 95% CI: −0.134, −0.049, p < 0.001) and HSI (β = −0.17, 95% CI: −0.30, −0.04, p = 0.011). Stronger associations were observed in premenopausal women with obesity. Mediterranean diet was inversely associated with NAFLD-FLS in women with overweight, independently of menopausal status. In conclusion, Mediterranean diet is associated with a better liver status in women with overweight and obesity. This may have a public health impact and be useful in drafting nutritional guidelines for NAFLD.
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Leitão C, Mignano A, Estrela M, Fardilha M, Figueiras A, Roque F, Herdeiro MT. The Effect of Nutrition on Aging-A Systematic Review Focusing on Aging-Related Biomarkers. Nutrients 2022; 14:nu14030554. [PMID: 35276919 PMCID: PMC8838212 DOI: 10.3390/nu14030554] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 02/08/2023] Open
Abstract
Despite the increasing life expectancy, an individual’s later years tends to be accompanied by a decrease in the quality of life. Though biological changes that occur through the natural process of aging cannot be controlled, the risk factors associated with lifestyle can. Thus, the main goal of this systematic review was to evaluate how nutrition can modulate aging. For this purpose, thirty-six studies were selected on (i) the efficiency of nutrition’s effect on aging, (ii) the evaluation of biomarkers that promote healthy aging, and (iii) how to increase longevity through nutrition, and their quality was assessed. The results showed that choosing low carbohydrate diets or diets rich in vegetables, fruits, nuts, cereals, fish, and unsaturated fats, containing antioxidants, potassium, and omega-3 decreased cardiovascular diseases and obesity risk, protected the brain from aging, reduced the risk of telomere shortening, and promoted an overall healthier life. With this study, the conclusion is that since the biological processes of aging cannot be controlled, changing one’s nutritional patterns is crucial to prevent the emergence and development of diseases, boost longevity, and, mostly, to enhance one’s quality of life and promote healthy aging.
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Affiliation(s)
- Catarina Leitão
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; (A.M.); (M.E.); (M.F.)
- Correspondence: (C.L.); (F.R.); (M.T.H.); Tel.: +351-915-468-330 (C.L.); +351-965-577-778 (F.R.); +351-917-739-799 (M.T.H.)
| | - Anna Mignano
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; (A.M.); (M.E.); (M.F.)
| | - Marta Estrela
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; (A.M.); (M.E.); (M.F.)
| | - Margarida Fardilha
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; (A.M.); (M.E.); (M.F.)
| | - Adolfo Figueiras
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28001 Madrid, Spain;
- Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Correspondence: (C.L.); (F.R.); (M.T.H.); Tel.: +351-915-468-330 (C.L.); +351-965-577-778 (F.R.); +351-917-739-799 (M.T.H.)
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; (A.M.); (M.E.); (M.F.)
- Correspondence: (C.L.); (F.R.); (M.T.H.); Tel.: +351-915-468-330 (C.L.); +351-965-577-778 (F.R.); +351-917-739-799 (M.T.H.)
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7
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Funuyet-Salas J, Martín-Rodríguez A, Pérez-San-Gregorio MÁ, Romero-Gómez M. Influence of Psychological Biomarkers on Therapeutic Adherence by Patients with Non-Alcoholic Fatty Liver Disease: A Moderated Mediation Model. J Clin Med 2021; 10:2208. [PMID: 34065216 PMCID: PMC8161151 DOI: 10.3390/jcm10102208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023] Open
Abstract
Our aim was to analyze whether depressive symptoms mediated the association between physical quality of life (QoL) and adherence to physical activity in patients with non-alcoholic fatty liver disease (NAFLD), as well as the association between social support and adherence to diet. We also examined whether self-efficacy exerted a moderating role in these associations. QoL (SF-12), social support (MSPSS), depressive symptoms (HADS), self-efficacy (GSE), physical activity (IPAQ) and diet (MEDAS) were evaluated in 413 biopsy-proven NAFLD patients. Mediation and moderated mediation models were conducted using the SPSS PROCESS v3.5 macro. Results showed that depressive symptoms mediated the relationship between physical QoL and adherence to physical activity (indirect effect = 6.248, CI = 1.917-10.727), as well as the relationship between social support and adherence to diet (indirect effect = 0.148, CI = 0.035-0.275). Self-efficacy also moderated the indirect effects of QoL and social support on therapeutic adherence through depressive symptoms. Specifically, the higher self-efficacy was, the lower the negative impact on the NAFLD patient's mental health. In conclusion, self-efficacy is defined as a protective factor for therapeutic adherence by NAFLD patients with a psychosocial risk profile. Self-efficacy should, therefore, be a main psychological target in future multidisciplinary NAFLD approaches.
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Affiliation(s)
- Jesús Funuyet-Salas
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Seville, 41018 Seville, Spain; (A.M.-R.); (M.Á.P.-S.-G.)
| | - Agustín Martín-Rodríguez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Seville, 41018 Seville, Spain; (A.M.-R.); (M.Á.P.-S.-G.)
| | - María Ángeles Pérez-San-Gregorio
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Seville, 41018 Seville, Spain; (A.M.-R.); (M.Á.P.-S.-G.)
| | - Manuel Romero-Gómez
- UCM Digestive Diseases and Ciberehd, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, 41013 Seville, Spain;
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