FATTY LIVER DISEASE IN NHS STAFF AND ROLE OF FIBROSCAN

ABSTRACT

Introduction It has never been more crucial to ensure the health and wellbeing of our colleagues. This study focuses on the impact of diet, alcohol and activity on the liver and anxiety levels were also reflected upon as a result of the Covid period on NHS staff. A Fibroscan (530, Compact, Echosens) was used as part of a staff 'Love your Liver 'clinic in a NHS general hospital, conducted by Hepatology nurses. Non-alcoholic fatty liver disease (NAFLD) is a rising health problem that can lead to non-alcoholic steatohepatitis (NASH) and cirrhosis with associated liver mortality. In the UK 63% of adults are obese and overweight, 1 in 3 people have earlystage NAFLD. In a previous study we conducted between 2018- 2020, 'NHS Biscuit Culture' 74 staff participated, 60 female and 14 male. Mean age 46.9 (range 25 -70). 59.4% had NAFLD with Controlled Attenuation Parameter (CAP) >248 dB/m with 16.2% also having associated fibrosis with Liver Stiffness Measure (LSM) >7.8 kPa. It was felt the results may act as a 'shock factor' to motivate lifestyle changes. Method 15 patients who were identified as having NAFLD were re-scanned 6 months later and were asked to follow advice on diet and lifestyle. 80% improved the CAP score with a mean reduction of 56.3dB/m. 20% CAP did not improve reported, diet was not changed. During November 2021, we offered a liver clinic to previously scanned staff to re-evaluate but many declined due to weight gain during Covid. Our event incorporated 45 staff, age range 30-71 years (mean age 42.6 years, 39 females, 6 males). Questionnaires were emailed to 45 participants. The questionnaire focused on diet, alcohol, anxiety levels and activity level at work. Results Fibroscan results 47% (n=45) fatty liver, CAP >243 dB/m and 2% (n=45) fibrosis with LSM >7.8 kPa. 9% borderline fatty liver, CAP of 231-237 dB/m and 7% borderline fibrosis LSM 6.2 -6.6 kPa. 18% staff were rescanned that previously had fatty liver in our previous liver events during 2018 to 2020, 50% (n=8) of fibroscan returned within normal range, 37.5% fat content had improved but fatty liver remained, 12.5% of the staff 's results remained the same, fatty liver, no fibrosis. Staff 's weekly diet included candy, sweetened drinks, fast food, fruit and vegetables. Candy 29%, Fast food 27%, sweetened beverages 16%, and 5 or more fruit a day 11%. 20% Staff were already on a diet. Admin staff 41% (n=45), 33% nursing staff, 22% pathology, radiology and dieticians, 2% doctors and 2% management attended the events. 11% currently drinking over 14 units a week (15-25 units), 15% drinking 10-14 units a week. Staff alcohol consumption did increase during the Covid. No alcohol consumption 47% (n=45), 1-5 units 20%, 5-10 units 9%. Mild anxiety 74% (range 0-5), moderate 15% (6-14) and severe 10% (15-21). Pre-existing high level of anxiety 2% of the staff, Covid increased anxiety levels due to increased pressures at work. 10% required further assessment. 56% had limited activity during the day due to job role and 44% regularly mobilised as part of their roles. Conclusion The study tells us that diet and lifestyle has a significant impact on hepatosteatosis. Incidence of NAFLD is considerably higher in staff members (47%) in a district general hospital as compared to the general population (25%). This could be secondary to levels of stress during the COVID pandemic. The study showed a significant reduction in CAP and LSM scores after simple lifestyle advice was given to a group of motivated healthcare workers.