Presence of Mood and/or Anxiety Disorders Does Not Affect Success of Weight Management Therapies in Metabolic Dysfunction-Associated Steatotic Liver Disease

Nov 28, 2024Digestive diseases and sciences

Mood or Anxiety Disorders Do Not Change How Well Weight Loss Treatments Work in Fatty Liver Disease with Metabolic Problems

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Abstract

Of 567 patients with metabolic dysfunction-associated steatotic liver disease, 64.6% had a mood and/or anxiety disorder.

The presence of a mood and/or anxiety disorder was not a significant predictor of achieving a 7% total body weight loss at 12 months.
Both groups—those with and without psychiatric disorders—showed similar improvements in liver health outcomes.
Effective treatments for achieving the 7% weight loss included semaglutide, phentermine-topiramate, and bariatric surgery.
Topiramate and phentermine-topiramate were identified as particularly effective treatments for patients with psychiatric comorbidities, despite being underutilized.

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BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) and resultant steatohepatitis (MASH) have been linked to psychiatric comorbidities. The treatment of MASLD/MASH primarily relies upon weight loss, where achieving a 7% total body weight loss is recommended to improve steatohepatitis. We aimed to determine whether achieving a 7% total body weight loss (TBWL) in MASLD/MASH patients was significantly different in the presence of a mood and/or anxiety disorder in an interdisciplinary clinic that integrates weight management and hepatology care.

METHODS: We conducted a single center retrospective cohort study of MASLD/MASH patients segregated into those with an ICD-10 diagnosis of a mood and/or anxiety disorder to those without. The primary outcome was reaching a 7% TBWL at 12 months with univariable and multivariable logistic regression models used to identify treatments predicting a 7% TBWL. Secondary outcomes were noninvasive assessment of steatohepatitis improvement, including change in ALT and FIB-4 scores.

RESULTS: Of 567 patients with MASLD/MASH, 366 (64.6%) had a mood and/or anxiety disorder. The presence of psychiatric disease was not a significant predictor of weight loss or any secondary outcome measures at 12 months. Significant predictors of achieving 7% TBWL at 12 months among all patients with MASLD/MASH included semaglutide, phentermine-topiramate, and bariatric surgery. Significant predictors of achieving 7% TBWL at 12 months in patients with MASLD/MASH and a psychiatric comorbidity included semaglutide, topiramate, phentermine-topiramate, and bariatric surgery. Both groups experienced similar improvements in hepatic outcomes.

CONCLUSIONS: Our findings suggest that obesity management in patients with MASLD/MASH performs similarly in the presence of comorbid mood and/or anxiety disorders. Topiramate and phentermine may be particularly effective in this patient population, yet are underutilized in routine hepatology practice.

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Presence of Mood and/or Anxiety Disorders Does Not Affect Success of Weight Management Therapies in Metabolic Dysfunction-Associated Steatotic Liver Disease

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