Behaviour regulation and the role of mental health in non-alcoholic fatty liver disease.

BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease in wealthy societies, and is responsible for a significant rise in liver morbidity and mortality. Current treatments prioritise lifestyle interventions, predominantly diet and exercise management, but patients frequently fail to make the necessary behavioural adjustments. The current study seeks to identify those factors which influence patients' behaviour with respect to adherence to treatment regimes. METHODS: Novel areas of interest were investigated; locus of control, behavioural regulation and a range of mental health measures, due to their links to either poor lifestyle choices or abnormal eating as identified in previous literature. Data was gathered using self-report questionnaires, from 96 participants, who were split into three groups, NAFLD patients, non-NAFLD liver disease patients and healthy controls RESULTS: Data was analysed using a MANOVA, and followed up with a Tukey post-hoc test. Three factors were found to be significant by group; cognitive restraint, uncontrolled eating and SAPAS score (a measure of personality disorders). An association between personality disorders and NAFLD was identified. CONCLUSION: It is suggested that NAFLD patients are screened for personality disorders and, if identified, treated prior to the commencement of diet and exercise management.

Uptake of screening for type 2 diabetes risk in general dental practice; an exploratory study.

Aim The objective of this study was to determine dental patients' uptake of two preliminary screening tools for risk of diabetes (the Finnish Diabetes Risk Score -FINDRISC- and HbA1c finger-prick testing) in general dental practice, and to determine the number of patients at risk of type 2 diabetes (T2D) based on the results of these screening tests.Methods Patients aged 45 and over, who did not already have a diagnosis of diabetes, visiting primary dental practitioners for routine appointments in London (N = 244) and Staffordshire (N = 276), were offered the chance to be screened for diabetes risk using the FINDRISC a self-report screening tool to assess risk of development of diabetes in the next ten years. If a patient's score showed them to be at risk, they were offered an instant HbA1c finger-prick test to further screen for possible type 2 diabetes, where they were given their result instantaneously. Patients found to be at risk on either screening test, were referred to their GP for formal diagnostic testing.Results A total of 1,035 patients eligible for inclusion were asked to take part. Five hundred and twenty patients consented to screening. Of these, 258 patients (49.6%) were found to be at risk of developing diabetes based on FINDRISC scores and were referred to the GP for further testing and offered a further screening finger-prick blood test at the dental practice. A total of 242 (93.8% of those offered the test) accepted the on the spot finger-prick test. On this A1c test, had a result of 5.7% or higher, indicating increased risk for diabetes. Of the 258 who were referred to their GP for formal diabetes testing, 155 (60%) contacted their doctor. There was a significant association between the number of 'at risk' screening results a person received and whether or not a patient contacted their GP (P <0.0001). The odds of patients contacting the GP was 3.22 times higher if they were referred with two positive diabetes risk results (positive FINDRISC, positive HbA1c) rather than just one (positive FINDRISC, negative HbA1c).Conclusions The study demonstrates a two-step method of diabetes screening that appears to be acceptable by dental patients, a sizeable proportion of whom were identified as at risk of developing diabetes, and the majority following the recommendation for further testing with their GP. While the majority followed the recommendation for further testing with their GP, patients were three times more likely to contact their GP if they received a positive risk result on both screening tools.