Nutrition
Qualitative analysis of patient surveys indicated that motivation, work, and time were barriers to attendance in the dietitian‐led program for patients with NAFLD, indicating modest improvements in metabolic risk factors.
Abstract
Background and Aim: Non‐alcoholic fatty liver disease (NAFLD) is emerging as a significant cause of chronic liver disease. Lifestyle modifications and weight loss are fundamental to NAFLD management. Patient‐centered, economical, and clinically effective lifestyle models of care are required to support patients with NAFLD. We aimed to examine the outcomes of a dietitian‐led program for patients with NAFLD. Methods: Groups of patients with NAFLD attended a 12‐week dietitian‐ led program at a tertiary hospital in Brisbane, Queensland, from December 2017 to February 2020. The program consists of an initial group session delivering lifestyle education, fortnightly individual “coaching” telephone calls, and a final group session. Weight, body mass index, waist circumference, and a Mediterranean diet quality score were recorded at the initial and conclusion sessions and statistically analyzed using SPSS. Qualitative data exploring barriers to attendance were collected using semi‐structured interviews and thematically analyzed. Results: A total of 192 patients with NAFLD, in 22 groups with an average of 10 patients per group, attended the dietitian‐led program during the study period. Of the 192 patients, 86 (44.8%) completed the program, with a median attendance rate of 88% for the group and telephone sessions. Patients who failed to attend the initial session, failed to attend two or more consecutive telephone reviews, and/or failed to attend the final session were named non‐attenders. Results are presented in Table 1. Anthropometry for attenders versus non‐attenders showed a statistically significant difference in baseline weight (98.1 vs 92.1 kg; P = 0.036) and waist circumference (111 vs 106 cm; P = 0.031). There was no difference in age or sex between attenders and non‐attenders. There was a trend of decreasing attendance rates as the program progressed, with 84% of patients attending the first phone call and only 59% the final phone call. There were no statistical correlations between attendance rate and changes in weight or waist circumference, possibly due to insufficient anthropometry data for non‐attenders. Of the 79 patients who commenced the program but did not attend the final group session, 12 (15%) did not attend any phone calls, 24 (30%) attended a single phone call only, 24 (30%) attended three to four phone calls, and 16 (20%) attended five or more phone calls. Qualitative analysis of patient surveys indicated that motivation, work, and time were barriers to attendance. Conclusion: The data show a statistically significant reduction in weight and waist circumference and an increase in diet quality, indicating modest improvements in metabolic risk factors. Patient attendance at the final group session was a limiting factor to data collection. Patients with a higher baseline weight and waist circumference were more likely to attend. Flexible services are required to ensure services are patient‐centered. The service has since been adapted to suit coronavirus disease 2019 restrictions; future studies will be completed to assess attendance rates at virtual and face‐to‐face modalities.