-Among a diverse vulnerable FLD population, majority reported experiencing stigma and barriers to lifestyle modifications. -Educational level, perceived stigma, and depression were associated with motivation to adhere to lifestyle modification. -Targeted interventions to mitigate perceived stigma and barriers and addressing mental health may enhance behavior change in FLD.
Abstract
Objectives
Adherence to lifestyle modification (diet, exercise, alcohol cessation) for fatty liver disease (FLD) management remains challenging. The study examined stigma, barriers, and factors associated with motivation to adhere to lifestyle modification in a diverse and vulnerable population with FLD.
Methods
From 2/19/2020 to 2/28/2022, 249 FLD patients within San Francisco safety-net hepatology clinics were surveyed along with clinical data from medical records. Multivariable modeling assessed factors associated with motivation to adhere to lifestyle modification in cross-sectional study.
Results
Median age was 53 yrs, 59% female, 59% Hispanic, 25% Asian/Pacific Islander, 9% White, and 2% Black, 79% were non-English speakers, 64% had ≤high school education, and 82% reported <$30,000 annual income. Common comorbidities included hyperlipidemia (47%), hypertension (42%), diabetes (39%), heavy alcohol use (22%). Majority (78%) reported experiencing stigma, 41% reported extreme motivation, and 58% reported ≥ two barriers. When controlling for age, sex, Hispanic ethnicity, alcohol consumption, BMI, >high school (coef 1.41, 95% CI 0.34-2.48), stigma (coef 0.34, 95% CI 0.07-0.62), and depression (coef -1.52, 95% CI -2.79 to -0.26) were associated with motivation.
Conclusions
Stigma is commonly reported among FLD patients. Interventions to enhance patient education and mental health support are critical to FLD management especially in vulnerable populations.
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