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Original research
Direct access lifestyle training improves liver biochemistry and causes weight loss but uptake is suboptimal in patients with non-alcoholic fatty liver disease
  1. Imran Patanwala1,
  2. Lili Emese Molnar2,
  3. Katherine Akerboom1,
  4. Katie Elizabeth Lane2
  1. 1Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  2. 2Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
  1. Correspondence to Dr Katie Elizabeth Lane, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; k.e.lane{at}


Objective To evaluate the uptake and effectiveness of an existing open access lifestyle intervention forged in collaboration between a third sector organisation, funded by local government and a secondary care non-alcoholic fatty liver disease (NAFLD) service in the North West of England.

Method A service outcome evaluation using precomparison design and postcomparison design was conducted to analyse changes between baseline clinical health records and 12-week follow-up for patients with NAFLD who completed the lifestyle intervention. Lifestyle factors, weight loss, changes in alanine aminotransferase (ALT) enzymes and lipid profiles were compared between patients who completed the programme vs 1:1 matched patients who did not.

Results Only 16 of 167 patients with NAFLD offered the intervention completed the programme. Intervention patients achieved significant weight loss (−2.3% p≤0.05) over 12 weeks, where the non-intervention group had non-significant weight gain (+0.95%). ALT improved by 20.6 IU/L in the interventional group and 15.75 IU/L in the non-intervention group; however, this was not statistically different.

Conclusion This study presents first of its kind evaluation of a service collaboration in the UK. Only 1 in 10 patients offered the opportunity completed the programme, a limitation that could affect future strategies. Patient and public involvement research is needed to identify barriers to participation, address adherence issues and identify support mechanisms for lifestyle interventions in patients with NAFLD.

  • fatty liver
  • nutritional status
  • nutritional support

Statistics from


  • Contributors IP contributed to article scrutiny, draft writing and agreed the final version. LEM conducted the data collection and statistical analyses and agreed the final version of the article. KA coordinated the lifestyle trainers and organised the intervention. KEL (guarantor of the article) comprised article drafts including the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Open access referral to lifestyle trainers was a service improvement offered to all patients attending the NAFLD clinic and therefore this was a service evaluation study, which did not need ethical approval. Data extracted for analysis were anonymised at source.

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

  • Data availability statement Data are available on reasonable request. Anonymised participant data are available from the corresponding author ORCID ID 0000-0002-9092-2927.

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