Review for 10.1186/s12876-020-01492-9 (2020)

Reviewer’s report
Title: 
Retrospective Analysis of a Dedicated Care Pathway for Nonalcoholic
Fatty Liver Disease in an Integrated US Healthcare System Demonstrates
Support of Weight Management and Improved ALT
Version: 
2 
Date: 
13 Sep 2020
Reviewer's report:
Dear Editor, 
Patton et al wrote a paper on a very interesting field of hepatology: the impact of
lifestyle interventions on the NAFLD status and outcomes. To do so, they
performed a retrospective study on a cohort of NAFLD patients (identified by
ICD code for NAFLD/NASH) undergone to a care pathway of the largest
American integrated managed care consortium, based in California. They
enrolled 632 patients, of whom about 28% attended an education program on
NAFLD. They evaluated the changes in liver stiffness measurement and ALT
after one year in those who participated the program and confronted it to the time
period before their participation. They also conducted a weight management
(WM) program in 24 (3.8%) patients of this cohort who accepted and evaluated
the importance of WM in weight loss after 12 months. They found that the
improvements in ALT and liver stiffness measurement were significantly higher
after participating the NAFLD program and that the weight loss was significantly
associated with higher levels of liver stiffness and WM program participation.
They concluded that to construct a care pathway for NAFLD improves the
management of NAFLD patients by improving the referral that, in turn,
ameliorates the outcomes. 
The paper, even if is not based on a very novel approach is very informative and
helpful in providing information on the effects of such cascade of care in
NAFLD patients, in whom the lifestyle interventions are, nowadays, the only
weapon we have. 
The paper already underwent a full revision which improved it, I have no
particular issues to raise. 
kindest regards
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