Perceptions of weight status and energy balance behaviors among patients with non-alcoholic fatty liver disease

Natalia I Heredia, Ruchi Gaba, Yan Liu, Shilpa Jain, Manasi Rungta, Manav Rungta, Hashem B El-Serag, Fasiha Kanwal, Aaron P Thrift, Maya Balakrishnan, Natalia I Heredia, Ruchi Gaba, Yan Liu, Shilpa Jain, Manasi Rungta, Manav Rungta, Hashem B El-Serag, Fasiha Kanwal, Aaron P Thrift, Maya Balakrishnan

Abstract

Weight loss through behavioral modification is central to treating non-alcoholic fatty liver disease (NAFLD). To achieve this, patients need to accurately self-perceive their health behaviors. We aimed to identify predictors of concordance between self-perception and objective measures of body weight, physical activity (PA) and dietary behaviors. We used data from the Harris County NAFLD Cohort, an ongoing prospective study in a regional safety-net healthcare system. Patients completed self-administered baseline questionnaires on demographics, diet, PA, and self-perceptions. We assessed concordance between actual and self-perceived body weight and energy-balance behaviors. Multivariable logistic regression identified predictors of concordance. Patients (n = 458; average age 46.5 years) were 90% Hispanic and 76% female. PA and fruit/vegetable intake guidelines were met among 37% and 9%, respectively. Most (89%) overweight/obese patients accurately perceived themselves as such. However, 41% of insufficiently-active and 34% of patients not meeting fruit/vegetable intake guidelines inaccurately self-perceived their behaviors as "just right". Women were 3 times more likely to accurately self-perceive weight status (adjusted odds ratio [AOR] 3.24; 95% CI 1.68-6.25) but 51% less likely to accurately self-perceive PA levels than men (AOR 0.49; 95% CI 0.29-0.81). Lower acculturation was associated with higher odds of accurate PA self-perception. Patients with prediabetes or diabetes vs normoglycemia were more likely to accurately self-perceive their fruit/vegetable intake. Most NAFLD patients accurately self-perceived their body weight. A third or more of those not meeting fruit/vegetable intake or PA guidelines had inaccurate perceptions about their behaviors. Our findings highlight key areas to target in NAFLD-specific behavioral modification programs.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

References

    1. Wong RJ, Aguilar M, Cheung R, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547–555.
    1. Makarova-Rusher OV, Altekruse SF, McNeel TS, et al. Population attributable fractions of risk factors for hepatocellular carcinoma in the United States. Cancer. 2016;122(11):1757–1765.
    1. Younossi ZM, Otgonsuren M, Henry L, et al. Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009. Hepatology. 2015;62(6):1723–1730.
    1. Stepanova M, Younossi ZM. Independent association between nonalcoholic fatty liver disease and cardiovascular disease in the US population. Clin. Gastroenterol. Hepatol. 2012;10(6):646–650.
    1. Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and therapeutic strategies. Nat. Med. 2018;24(7):908–922.
    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84.
    1. Balakrishnan M, Patel P, Dunn-Valadez S, et al. Women have lower risk of nonalcoholic fatty liver disease but higher risk of progression vs men: A systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. (2020).
    1. Keating SE, Hackett DA, George J, Johnson NA. Exercise and non-alcoholic fatty liver disease: A systematic review and meta-analysis. J. Hepatol. 2012;57(1):157–166.
    1. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–378.
    1. Marchesini G, Petta S, Dalle GR. Diet, weight loss, and liver health in nonalcoholic fatty liver disease: Pathophysiology, evidence, and practice. Hepatology. 2016;63(6):2032–2043.
    1. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328–357.
    1. Marshall SJ, Biddle SJ. The transtheoretical model of behavior change: A meta-analysis of applications to physical activity and exercise. Ann. Behav. Med. 2001;23(4):229–246.
    1. Prochaska JO, Redding CA, Evers KE. The transtheoretical model and stages of change. In: Glanz K, Rimer B, Wiswanath K, editors. Health behavior: Theory, research, and practice. 5. John Wiley & Sons, Inc; 2015. pp. 125–148.
    1. Rich NE, Oji S, Mufti AR, et al. Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. 2018;16(2):198–210.
    1. Dorsey RR, Eberhardt MS, Ogden CL. Racial and ethnic differences in weight management behavior by weight perception status. Ethn. Dis. 2010;20(3):244.
    1. Kuchler F, Variyam JN. Mistakes were made: misperception as a barrier to reducing overweight. Int. J. Obes. 2003;27(7):856–861.
    1. Cui Z, Stevens J, Truesdale KP, Zeng D, French S, Gordon-Larsen P. Prediction of body mass index using concurrently self-reported or previously measured height and weight. PLoS ONE. 2016;11(11):7288.
    1. Lemon SC, Goins KV, Schneider KL, et al. Municipal officials' participation in built environment policy development in the United States. Am. J. Health Promot. 2015;30(1):42–49.
    1. Langellier BA, Glik D, Ortega AN, Prelip ML. Trends in racial/ethnic disparities in overweight self-perception among US adults, 1988–1994 and 1999–2008. Public Health Nutr. 2015;18(12):2115–2125.
    1. Ahluwalia IB, Ford ES, Link M, Bolen JC. Acculturation, weight, and weight-related behaviors among Mexican Americans in the United States. Ethn. Dis. 2007;17(4):643.
    1. DeSalvo KB, Olson R, Casavale KO. Dietary guidelines for Americans. JAMA. 2016;315(5):457–458.
    1. Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–2028.
    1. Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., & Monteiro, M.G. AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care. World Health Organization (2001).
    1. World Health Organization . Obesity: Preventing and managing the global epidemic: Report of a WHO consultation. World Health Organization; 2000. p. 9241208945.
    1. Topolski TD, LoGerfo J, Patrick DL, Williams B, Walwick J, Patrick MMB. Peer reviewed: The Rapid Assessment of Physical Activity (RAPA) among older adults. Prev. Chronic. Dis. 2006;3(4):1.
    1. Vega-López S, Chavez A, Farr KJ, Ainsworth BE. Validity and reliability of two brief physical activity questionnaires among Spanish-speaking individuals of Mexican descent. BMC. Res. Notes. 2014;7(1):29.
    1. American College of Sports Medicine . ACSM's guidelines for exercise testing and prescription. 10. Lippincott Williams & Wilkins; 2017.
    1. Smith TM, Calloway EE, Pinard CA, et al. Using secondary 24-hour dietary recall data to estimate daily dietary factor intake from the FLASHE study dietary screener. Am. J. Prev. Med. 2017;52(6):856–862.
    1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. December 2015.
    1. National Cancer Institute. 2014 Family Life, Activity, Sun, Health and Eating (FLASHE) Survey Data. In. Rockville, MD: U.S. Department of Health and Human Services, National Cancer Institute.
    1. Gleason, P., Rangarajan, A., Olson, C.M. Dietary intake and dietary attitudes among food stamp participants and other low-income individuals. Mathematica Policy Research, Incorporated (2000).
    1. Obayashi S, Bianchi LJ, Song WO. Reliability and validity of nutrition knowledge, social-psychological factors, and food label use scales from the 1995 Diet and Health Knowledge Survey. J. Nutr. Educ. Behav. 2003;35(2):83–92.
    1. Capps O, Cleveland L, Park J. Dietary behaviors associated with total fat and saturated fat intake. J. Am. Diet. Assoc. 2002;102(4):490–502.
    1. U.S. Department of Agriculture ARS. Diet and Health Knowledge Survey 1994–1996. . Accessed May 18 2015.
    1. Oppen, M., Sugerman, S., & Foerster, S. Fruit and vegetable consumption in California adults: Ten-year highlights from the california dietary practices surveys 1989–1999. In Sacramento, CA: California Department of Health Services, Cancer Prevention and Nutrition Section (2002).
    1. Johns DJ, Hartmann-Boyce J, Jebb SA, Aveyard P, Group BWMR Diet or exercise interventions vs combined behavioral weight management programs: A systematic review and meta-analysis of direct comparisons. J. Acad. Nutr. Diet. 2014;114(10):1557–1568.
    1. Jansink R, Braspenning J, Keizer E, Van Der Weijden T, Elwyn G, Grol R. Misperception of patients with type 2 diabetes about diet and physical activity, and its effects on readiness to change. J. Diabetes. 2012;4(4):417–423.
    1. Liver EAftSot, Diabetes EAftSo. EASL-EASD-EASO Clinical practice guidelines for the management of non-alcoholic fatty liver disease. J. Hepatol.64(6), 1388–1402 (2016).
    1. Eslam M, Sarin SK, Wong VW-S, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Hepatol. Int. 2020;1:1–31.
    1. Bamia C, Lagiou P, Jenab M, et al. Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study. Br. J. Cancer. 2015;112(7):1273–1282.
    1. Yang Y, Zhang D, Feng N, et al. Increased intake of vegetables, but not fruit, reduces risk for hepatocellular carcinoma: A meta-analysis. Gastroenterology. 2014;147(5):1031–1042.
    1. Akhlaghi M, Ghasemi-Nasab M, Riasatian M. Mediterranean diet for patients with non-alcoholic fatty liver disease, a systematic review and meta-analysis of observational and clinical investigations. J. Diabetes Metab. Disord. 2020;19(1):575–584.
    1. Guveli H, Kenger EB, Ozlu T, Kaya E, Yilmaz Y. Macro-and micronutrients in metabolic (dysfunction) associated fatty liver disease: Association between advanced fibrosis and high dietary intake of cholesterol/saturated fatty acids. Eur. J. Gastroenterol. Hepatol. 2021;33:390.
    1. Vos MB, Lavine JE. Dietary fructose in nonalcoholic fatty liver disease. Hepatology. 2013;57(6):2525–2531.
    1. Lim JS, Mietus-Snyder M, Valente A, Schwarz J-M, Lustig RH. The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome. Nat. Rev. Gastroenterol. Hepatol. 2010;7(5):251.
    1. Jiao J, Watt GP, Lee M, et al. Cirrhosis and advanced fibrosis in Hispanics in Texas: The dominant contribution of central obesity. PLoS ONE. 2016;11(3):1.
    1. Gardner RM. Weight status and the perception of body image in men. Psychol. Res. Behav. Manag. 2014;7:175.
    1. Balakrishnan M, Kanwal F, El-Serag HB, Thrift AP. Acculturation and nonalcoholic fatty liver disease risk among hispanics of mexican origin: Findings from the National Health and Nutrition Examination Survey. Clin. Gastroenterol. Hepatol. 2017;15(2):310–312.
    1. Crespo CJ, Smit E, Carter-Pokras O, Andersen R. Acculturation and leisure-time physical inactivity in Mexican American adults: results from NHANES III, 1988–1994. Am. J. Public Health. 2001;91(8):1254–1257.
    1. Abraido-Lanza AF, Chao MT, Florez KR. Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox. Soc. Sci. Med. 2005;61(6):1243–1255.
    1. Adams SA, Matthews CE, Ebbeling CB, et al. The effect of social desirability and social approval on self-reports of physical activity. Am. J. Epidemiol. 2005;161(4):389–398.
    1. Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review. Int. J. Behav. Nutr. Phys. Act. 2008;5(1):56.
    1. Centis E, Moscatiello S, Bugianesi E, et al. Stage of change and motivation to healthier lifestyle in non-alcoholic fatty liver disease. J. Hepatol. 2013;58(4):771–777.
    1. Dhaliwal HS, Singh R, Abraham AM, et al. Perception of illness and its association with treatment willingness in patients with newly diagnosed nonalcoholic fatty liver disease. Dig. Dis. Sci. 2021;66:1–11.
    1. Frith J, Day CP, Robinson L, Elliott C, Jones DE, Newton JL. Potential strategies to improve uptake of exercise interventions in non-alcoholic fatty liver disease. J. Hepatol. 2010;52(1):112–116.
    1. Heredia, N.I., Thrift, A.P., & Balakrishnan, M. Perceived barriers to weight loss among hispanic patients with non-alcoholic fatty liver disease. Hisp. Health Care Int. 15404153211043885 (2021).
    1. O’Gorman P, Monaghan A, McGrath M, Naimimohasses S, Gormley J, Norris S. Determinants of physical activity engagement in patients with nonalcoholic fatty liver disease: The need for an individualized approach to lifestyle interventions. Phys. Ther. 2021;101(2):195.
    1. Stewart KE, Haller DL, Sargeant C, Levenson JL, Puri P, Sanyal AJ. Readiness for behaviour change in non-alcoholic fatty liver disease: Implications for multidisciplinary care models. Liver Int. 2015;35(3):936–943.
    1. Stine JG, Soriano C, Schreibman I, et al. Breaking down barriers to physical activity in patients with nonalcoholic fatty liver disease. Dig. Dis. Sci. 2020;1:1–8.
    1. Zelber-Sagi S, Bord S, Dror-Lavi G, et al. Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients. World J. Gastroenterol. 2017;23(10):1881.
    1. Eslam M, Newsome PN, Anstee QM, et al. A new definition for metabolic associated fatty liver disease: An international expert consensus statement. J. Hepatol. 2020;1:1.

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