Dietitian-led Mediterranean diet program leads to weight loss, diet change, and reduction in waist circumference in patients with non-alcoholic fatty liver disease

ABSTRACT

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is emerging as a significant cause of chronic liver disease. Lifestyle modifications and weight loss are fundamental to NAFLD management. Patient-centered, economical, and clinically effective lifestyle models of care are required to support patients with NAFLD. We aimed to examine the outcomes of a dietitian-led program for patients with NAFLD. Methods: Groups of patients with NAFLD attended a 12-week dietitianled program at a tertiary hospital in Brisbane, Queensland, from December 2017 to February 2020. The program consists of an initial group session delivering lifestyle education, fortnightly individual “coaching” telephone calls, and a final group session. Weight, body mass index, waist circumference, and a Mediterranean diet quality score were recorded at the initial and conclusion sessions and statistically analyzed using SPSS. Qualitative data exploring barriers to attendance were collected using semi-structured interviews and thematically analyzed. Results: A total of 192 patients with NAFLD, in 22 groups with an average of 10 patients per group, attended the dietitian-led program during the study period. Of the 192 patients, 86 (44.8%) completed the program, with a median attendance rate of 88% for the group and telephone sessions. Patients who failed to attend the initial session, failed to attend two or more consecutive telephone reviews, and/or failed to attend the final session were named non-attenders. Results are presented in Table 1. Anthropometry for attenders versus non-attenders showed a statistically significant difference in baseline weight (98.1 vs 92.1 kg;P = 0.036) and waist circumference (111 vs 106 cm;P = 0.031). There was no difference in age or sex between attenders and non-attenders. There was a trend of decreasing attendance rates as the program progressed, with 84% of patients attending the first phone call and only 59% the final phone call. There were no statistical correlations between attendance rate and changes in weight or waist circumference, possibly due to insufficient anthropometry data for non-attenders. Of the 79 patients who commenced the program but did not attend the final group session, 12 (15%) did not attend any phone calls, 24 (30%) attended a single phone call only, 24 (30%) attended three to four phone calls, and 16 (20%) attended five or more phone calls. Qualitative analysis of patient surveys indicated that motivation, work, and time were barriers to attendance. Conclusion: The data show a statistically significant reduction in weight and waist circumference and an increase in diet quality, indicating modest improvements in metabolic risk factors. Patient attendance at the final group session was a limiting factor to data collection. Patients with a higher baseline weight and waist circumference were more likely to attend. Flexible services are required to ensure services are patient-centered. The service has since been adapted to suit coronavirus disease 2019 restrictions;future studies will be completed to assess attendance rates at virtual and face-to-face modalities.