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Liver
Original article
A multidisciplinary approach to the management of NAFLD is associated with improvement in markers of liver and cardio-metabolic health
  1. Ahmad Moolla1,2,
  2. Kenzo Motohashi1,
  3. Thomas Marjot1,3,
  4. Amelia Shard3,
  5. Mark Ainsworth3,
  6. Alastair Gray4,
  7. Rury Holman2,5,
  8. Michael Pavlides2,3,
  9. John D Ryan2,3,
  10. Jeremy W Tomlinson1,2,
  11. Jeremy F Cobbold2,3
  1. 1 Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK
  2. 2 National Institutes of Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
  3. 3 Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  5. 5 Diabetes Trial Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
  1. Correspondence to Dr Jeremy F Cobbold, National Institutes of Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford OX1 2JD, UK; jeremy.cobbold{at}ouh.nhs.uk

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a globally prevalent health problem, associated in its more severe forms with increased liver-related and cardiovascular-related morbidity and mortality. We established a multidisciplinary metabolic hepatology clinic in 2014 and have analysed the clinical data to evaluate the effectiveness of this service.

Patients with NAFLD (n=165) who had attended two or more appointments were included. Prespecified clinical data were collected prospectively at clinic appointments and analysed retrospectively. Interventions offered included lifestyle advice, signposting to weight loss services and pharmacological treatment of diabetes and cardiovascular risk factors.

Median follow-up was 13 months (range: 2–34). 59% (n=97) of patients had type 2 diabetes mellitus (T2DM). 53% (n=87) underwent liver biopsy of whom 18% (n=16) had cirrhosis. Median alanine aminotransferase (ALT) reduced by 11 IU/L (p<0.0001), median weight reduced by 3.3 kg (p=0.0005). There were significant reductions in HbA1c, total cholesterol and liver stiffness. Specifically, in patients with T2DM, HbA1c decreased by 4 mmol/mol (p=0.01) with significant reductions in ALT, weight and total cholesterol. Relative cardiovascular risk assessed by the QRISK3 score reduced in the whole cohort and in those with T2DM. Health economic modelling suggested the clinic intervention among those patients with poorly controlled T2DM was cost-effective.

In conclusion, a multidisciplinary approach to the management of patients with NAFLD in this observational cohort study was associated with improvements in liver-related and cardio-metabolic related health parameters and with evidence of cost-effectiveness in patients with poorly controlled T2DM.

  • fatty liver
  • economic evaluation
  • diabetes mellitus
  • non-alcoholic steatohepatitis

https://doi.org/10.1136/flgastro-2018-101155

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    Footnotes

    • Contributors JFC, AM and JT planned and designed the study and take overall responsibility for the content. JFC and JT jointly lead the metabolic hepatology clinical service at OUH NHS Trust described in the manuscript and along with AM, MP, JDR and MA provide clinical care to subjects attending this service. AM, KM, MA, TM and AS collated the clinical data analysed. AM and KM undertook the primary data analysis. AM, KM, RH and AG designed and undertook the health economic analysis. AM, KM, JT and JFC wrote the manuscript which all authors subsequently reviewed and contributed to.

    • Funding This work was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), by the Medical Research Council (programme grant to JWT) and AM was supported by a Novo Nordisk Clinical Research Fellowship run in partnership with the University of Oxford.

    • Competing interests JFC and JT have received consultancy fees from Novo Nordisk. JFC has received speaker fees from Intercept Pharmaceuticals.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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