title: Stage of change and motivation to healthier lifestyle in non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  Healthy diet and physical activity are the treatment cornerstones of non-alcoholic fatty liver disease (NAFLD); their effectiveness is however limited by difficulties in implementing lifestyle changes. We aimed at determining the stage of change and associated psychological factors as a prerequisite to refine strategies to implement behavior changes.
  
  
  METHODS
  We studied 138 consecutive NAFLD patients (73% male, age 19-73 years). The diagnosis was confirmed by liver biopsy in 64 cases (steatohepatitis, 47%). All cases completed the validated EMME-3 questionnaire, consisting of two parallel sets of instruments (for diet and physical activity, respectively) and providing stages of change according to transtheoretical model. Logistic regression analysis was used to identify factors associated with stages making behavioral changes more demanding.
  
  
  RESULTS
  The individual profiles were variable; for diet, no cases had precontemplation as prevalent stage of change (highest score in individual profiles); 36% had contemplation. For physical activity, 50% were classified in either precontemplation or contemplation. Minor differences were recorded in relation to associated metabolic complications or steatohepatitis. Logistic regression identified male sex (odds ratio, 4.51; 95% confidence interval, 1.69-12.08) and age (1.70; 1.20-2.43 per decade) as the independent parameters predicting precontemplation or contemplation for diet. No predictors were identified for physical activity.
  
  
  CONCLUSIONS
  NAFLD cases have scarce readiness to lifestyle changes, particularly with regard to physical activity. Defining stages of change and motivation offers the opportunity to improve clinical care of NAFLD people through individual programs exploiting the powerful potential of behavioral counseling, an issue to be tested in longitudinal studies.
authors.affiliation: Unit of Metabolic Diseases and Clinical Dietetics, Alma Mater Studiorum University, Bologna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Centis
authors.forename: Simona
authors.initials: S
authors.lastname: Moscatiello
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bugianesi
authors.forename: Stefano
authors.initials: S
authors.lastname: Bellentani
authors.forename: Anna Ludovica
authors.initials: AL
authors.lastname: Fracanzani
authors.forename: Simona
authors.initials: S
authors.lastname: Calugi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.forename: Riccardo
authors.initials: R
authors.lastname: Dalle Grave
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
mesh_terms: D000328:Adult; D000368:Aged; D004032:Diet; D005234:Fatty Liver / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009043:Motor Activity; D065626:Non-alcoholic Fatty Liver Disease; D055815:Young Adult