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

Bryan Bollinger; Robert Cotter; Yanhong Deng; Ysabel Ilagan-Ying; Vikas Gupta

doi:10.1007/s10620-024-08724-y

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

Dig Dis Sci. 2024 Nov 27. doi: 10.1007/s10620-024-08724-y. Online ahead of print.

Authors

Bryan Bollinger¹, Robert Cotter¹, Yanhong Deng², Ysabel Ilagan-Ying³, Vikas Gupta⁴

Affiliations

¹ Yale University School of Medicine, New Haven, CT, USA.
² Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA.
³ Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar St., TAC S241, New Haven, CT, 06519, USA.
⁴ Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar St., TAC S241, New Haven, CT, 06519, USA. Vikas.Gupta@yale.edu.

PMID: 39604664
DOI: 10.1007/s10620-024-08724-y

Abstract

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.

Keywords: Anxiety; Depression; Medical weight loss; Metabolic dysfunction-associated steatotic liver disease.