Abstract
BACKGROUND AND AIMS: Steatotic liver disease (SLD) is strongly associated with diabetes. These diseases disproportionately impact marginalized populations, for whom lifestyle modifications, a mainstay of treatment, can be challenging. This study aimed to assess change in liver enzyme alanine aminotransferase (ALT), body mass index (BMI), and hemoglobin A1c (HbA1c) following SLD education in a safety-net health-care system. METHODS: From February 2020 to February 2024, participants attended a 60-minute SLD class. Clinical measures were collected at baseline and posteducation. Baseline factors associated with change in ALT, BMI, and HbA1c were assessed using linear mixed-effects modeling. Factors associated with ALT normalization were assessed using competing risk analyses. RESULTS: Among the 392 participants, median age was 53 years, 58% women, 53% Hispanic, and 36% had diabetes. Hypertension and hyperlipidemia were more common among patients with diabetes. Overall, 330 attended the SLD class. On multivariable analysis, obesity was associated with lesser change in ALT; age was associated with lesser change in BMI; and race or ethnicity and higher ALT were associated with lesser change in HbA1c. Among patients with abnormal baseline ALT (N = 201), posteducation motivation to adhere to lifestyle modifications was associated with increased likelihood of persistent ALT normalization. No significant differences were observed based on diabetes status. CONCLUSION: In this longitudinal study of an SLD education intervention, patients with diabetes achieved a similar ALT reduction to patients without diabetes. Higher posteducation motivation was associated with increased likelihood of sustained ALT normalization. Future studies should assess the impact of education on adaptation of lifestyle modifications and clinical outcomes among vulnerable populations.