Date of Award

January 2024

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Vikas Gupta

Abstract

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 likelihood of 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.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 fibrosis-4 (FIB-4) scores. 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 achieving 7% TBWL. There were no significant differences in secondary outcomes between the group of patients with an ICD-10 diagnosis of a mood and/or anxiety disorder compared to those without. 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. 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 hepatology practices.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/14/2026

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