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Piloting a multidisciplinary clinic for the management of non-alcoholic fatty liver disease: initial 5-year experience
  1. Jeremy F L Cobbold1,
  2. Sarrah Raveendran1,
  3. Christopher M Peake1,
  4. Quentin M Anstee2,
  5. Michael S Yee3,
  6. Mark R Thursz1
  1. 1Hepatology and Gastroenterology Section, Department of Medicine, Imperial College London, London, UK
  2. 2Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK
  3. 3Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr J F L Cobbold, Hepatology and Gastroenterology Section, Department of Medicine, Imperial College London, Liver Unit, 10th Floor, QEQM building, St Mary's Hospital Campus, Praed Street, London W2 1NY, UK; j.cobbold{at}imperial.ac.uk

Abstract

Objective A multidisciplinary approach is advocated for the management of Non-Alcoholic Fatty Liver Disease (NAFLD), but few clinical data exist to support this. The objective of this study was to investigate the effectiveness of a multidisciplinary NAFLD clinic using surrogate markers of liver injury and cardiovascular risk.

Design Retrospective survey of clinical practice.

Setting The multidisciplinary NAFLD clinic in a secondary/tertiary care setting with hepatology, diabetology, dietetic and exercise therapy input: initial 5-years’ experience (2007–2012).

Patients 180 patients with NAFLD but without hepatic comorbidities were followed up for a median of 19.5 (range 3–57) months. 52% had type 2 diabetes mellitus, 48% were Europoid Caucasian, 17% were South Asian.

Interventions Multiple clinical interventions were employed including lifestyle (diet and exercise) advice, pharmacological intervention for cardiovascular risk factors, weight loss and exercise therapy.

Main outcome measures Change in alanine aminotransferase (ALT), weight, HbA1c, lipid profile and blood pressure.

Results Median ALT fell from 61 (12–270) U/l to 50 (11–221) U/l, −18%, p<0.001, and weight fell from 90.5 (42.7–175.0) kg to 87.3 (45.9–175.3) kg, −3.5%, p<0.001. There were significant improvements in total cholesterol overall, triglycerides (among dyslipidaemic patients), HbA1c (among diabetic patients) and systolic blood pressure (among hypertensive patients). 24% of patients achieved ≥7% weight loss during follow-up and 17% maintained this weight loss throughout.

Conclusions Improvement in liver biochemistry and cardiovascular risk factors was seen in patients attending the multidisciplinary NAFLD clinic. Refinement of this approach is warranted in light of these data, novel therapies and a growing evidence base.

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