S1358 Nonalcoholic Fatty Liver Disease Outcomes in Patients With Comorbid Psychiatric Disorders Improved by Integrated Medical Weight Management and Hepatology Clinic Care

Abstract

Introduction: Nonalcoholic fatty liver disease (NAFLD) affects 25% of Americans and is associated with worse histological findings in patients with mood and anxiety-related disorders. Many psychopharmacotherapies cause weight gain, which can further worsen this disease. Thus, we studied clinical characteristics and characterized psychopharmacotherapy prescription patterns in patients of the Yale Fatty Liver Disease Program (YFLDP), which integrates weight management and hepatology care, including medication review to minimize obesogenic contributors. Methods: We extracted clinical, laboratory, prescription, and non-invasive fibrosis testing data. Patients were classified as having NAFLD and psychiatric disorders using diagnostic codes. We compared patients with mood disorders (ICD-10 F30-F39) (M+), anxiety-related disorders (ICD-10 F40-F48) (A+), or both (MA+), to those without mood or anxiety-related disorders (MA-). Psychopharmacotherapy treatment was defined as prescription for at least 90 days with consecutive breaks of < 32 days. We compared demographics, prescription rates, and non-invasive liver fibrosis changes. Statistical significance was set as a two-tailed p< 0.05. Results: There were 969 patients with NAFLD (91 M+, 158 A+, 314 MA+, and 406 MA-). Differences in gender and insurance status were observed between groups. NAFLD-related outcomes were not significantly different from MA- patients in M+, A+, and MA+ patients, though MA+ patients achieved significantly greater % weight loss than MA- patients (Table). Prevalence of several obesogenic and leptogenic psychopharmacotherapies were significantly greater in M+, A+, and MA+ patients (Figure). Conclusion: The prevalence of weight-modifying psychotropic medications is high in patients with comorbid mood and anxiety-related disorders. Contrary to prior findings, we found no difference in non-invasive liver fibrosis changes between patients with comorbid mood and anxiety disorders, and some of these patients had more weight loss than those without these psychiatric disorders. This suggests that specialty weight loss management supports standard liver care regardless of the presence of comorbid psychiatric disorders. Future studies to compare NAFLD outcomes in these patient populations with and without specialty clinic care, and to evaluate the effects of these drugs on NAFLD outcomes, would further clarify differences in this patient population. Table 1. - Demographic Characteristics and Clinical Outcomes in Nonalcoholic Fatty Liver Disease Patients (NAFLD) with and without Comorbid Mood and Anxiety-related Disorders NAFLD Patient Characteristics MA-, ref (n=406) M+ (n=91) p MA- vs. M+ A+ (n=158) p MA- vs. A+ MA+ (n=314) p MA- vs. MA+ Mean Age years (SD) 54.5 (13.3) 55.3 (12.6) 0.57 53 (14.0) 0.25 51.3 (13.3) Sex n (%) 0.0003 * < 0.0001 * < 0.0001 * Female 178 (43.8) 59 (64.8) 100 (63.3) 227 (72.3) Male 228 (56.2) 32 (35.2) 58 (36.7) 87 (27.7) Race n (%) 0.75 0.29 0.98 White 317 (78.1) 73 (80.2) 130 (82.3) 247 (78.7) Black 33 (8.1) 9 (9.9) 6 (3.8) 25 (8.0) Other 45 (11.1) 7 (7.7) 19 (12.0) 35 (11.1) Unknown 11 (2.7) 2 (2.2) 3 (1.9) 7 (2.2) Ethnicity n (%) 0.19 0.67 0.36 Non-Hispanic 351 (86.5) 76 (83.5) 132 (83.5) 267 (85.0) Hispanic 47 (11.6) 15 (16.5) 22 (13.9) 44 (14.0) Unknown 8 (2.0) 0 (0) 4 (2.5) 3 (1.0) Insurance Status n (%) 0.0065 * 0.0472 * < 0.0001 * Uninsured 9 (2.2) 4 (4.4) 1 (0.6) 6 (1.9) Medicaid 46 (11.3) 21 (23.1) 31 (19.6) 78 (24.8) Medicare 99 (24.4) 24 (26.4) 36 (22.8) 77 (24.5) Private 252 (62.1) 42 (46.2) 90 (57.0) 153 (48.7) Initial Mean BMI kg/m2 (SD) 35.0 (7.7) 37.5 (9) 0.01 * 35.6 (8.1) 0.43 36.6 (8.5) 0.01 * Average Change in NAFLD Clinical Outcomes mean (SD) % Weight -2.5 (10.2) -4.3 (10.8) 0.14 -3.1 (8.5) 0.43 -4.4 (9.9) 0.01 * Hba1c -0.3 (1.2) -0.4 (1) 0.52 -0.1 (1.1) 0.35 -0.2 (1) 0.61 Total Cholesterol -2.9 (33.1) -4.7 (33.4) 0.75 -7.7 (37.8) 0.32 -5.5 (41.3) 0.52 INR 0.1 (0.6) -0.1 (0.4) 0.15 0 (0.2) 0.30 0.1 (0.3) 0.84 FibroScan® Stiffness 21.0 (61.1) 38.8 (48.2) 0.54 4.7 (24.5) 0.28 8.7 (90.2) 0.71 Fibrosis-4 Score 5.6 (48.3) -0.2 (40.9) 0.33 13.4 (67.7) 0.27 13.9 (176.8) 0.48 NAFLD Fibrosis Score -186.0 (1731.3) 3.7 (266.9) 0.21 36 (552.5) 0.17 -96.6 (936.1) 0.58 *p<0.05. MA- = NAFLD patients without Mood or Anxiety Disorders (reference group), M+ = NAFLD Patients with Mood Disorders, A+ NAFLD Patients with Anxiety-related Disorders, MA+ NAFLD patients with Mood and Anxiety Disorders, BMI = body mass index, Hba1c = hemoglobin a1c. Figure 1.: Prevalence of Psychotropic and Weight Loss Medication Use Among Patients with Nonalcoholic Fatty Liver Disease (NAFLD) and Comorbid Mood and Anxiety-related Disorders. A) NAFLD + Mood Disorders (M+) vs. NAFLD. B) NAFLD + Anxiety-Related Disorders (A+) vs. NAFLD. C) NAFLD + Mood Disorders and Anxiety-Related Disorders (MA+) vs. NAFLD. *p<0.05.