Initial outcomes of a dedicated multidisciplinary non-alcoholic fatty liver disease clinic: a retrospective cohort study.
FibroScan
MAFLD
NAFLD
liver function tests
multidisciplinary
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
02
06
2022
accepted:
12
02
2023
medline:
27
11
2023
pubmed:
8
3
2023
entrez:
7
3
2023
Statut:
ppublish
Résumé
Non-alcoholic fatty liver disease (NAFLD) is a major healthcare burden. Real-world outcomes in dedicated tertiary care settings in Australia remain unknown. To evaluate the initial outcomes of patients referred to a dedicated multidisciplinary tertiary care NAFLD clinic. Retrospective review of all adult patients with NAFLD who attended a dedicated tertiary care NAFLD clinic between January 2018 and February 2020 and who had two clinic visits and FibroScans at least 12 months apart. Demographic and health-related clinical and laboratory data were extracted from electronic medical records. Key outcome measures were serum liver chemistries, liver stiffness measurement (LSM) and weight control at 12 months. A total of 137 patients with NAFLD were included. Median (interquartile range (IQR)) follow-up time was 392 days (343-497 days). One hundred and eleven patients (81%) achieved weight control (i.e. weight loss or stability). Markers of liver disease activity were significantly improved, including median (IQR) serum alanine aminotransferase (48 (33-76) vs 41 (26-60) U/L, P = 0.009) and aspartate aminotransferase (35 (26-54) vs 32 (25-53) U/L, P = 0.020). Median (IQR) LSM across the whole cohort was significantly improved (8.4 (5.3-11.8) vs 7.0 (4.9-10.1) kPa, P = 0.001). No significant reduction was observed in mean body weight or the frequency of metabolic risk factors. This study highlights a new model of care for patients with NAFLD and demonstrates promising initial outcomes in relation to significant reductions in markers of liver disease severity. Although most patients achieved weight control, further refinements are needed to achieve significant weight reduction including more frequent and structured dietetic and/or pharmacotherapeutic interventions.
Sections du résumé
BACKGROUND
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is a major healthcare burden. Real-world outcomes in dedicated tertiary care settings in Australia remain unknown.
AIM
OBJECTIVE
To evaluate the initial outcomes of patients referred to a dedicated multidisciplinary tertiary care NAFLD clinic.
METHODS
METHODS
Retrospective review of all adult patients with NAFLD who attended a dedicated tertiary care NAFLD clinic between January 2018 and February 2020 and who had two clinic visits and FibroScans at least 12 months apart. Demographic and health-related clinical and laboratory data were extracted from electronic medical records. Key outcome measures were serum liver chemistries, liver stiffness measurement (LSM) and weight control at 12 months.
RESULTS
RESULTS
A total of 137 patients with NAFLD were included. Median (interquartile range (IQR)) follow-up time was 392 days (343-497 days). One hundred and eleven patients (81%) achieved weight control (i.e. weight loss or stability). Markers of liver disease activity were significantly improved, including median (IQR) serum alanine aminotransferase (48 (33-76) vs 41 (26-60) U/L, P = 0.009) and aspartate aminotransferase (35 (26-54) vs 32 (25-53) U/L, P = 0.020). Median (IQR) LSM across the whole cohort was significantly improved (8.4 (5.3-11.8) vs 7.0 (4.9-10.1) kPa, P = 0.001). No significant reduction was observed in mean body weight or the frequency of metabolic risk factors.
CONCLUSIONS
CONCLUSIONS
This study highlights a new model of care for patients with NAFLD and demonstrates promising initial outcomes in relation to significant reductions in markers of liver disease severity. Although most patients achieved weight control, further refinements are needed to achieve significant weight reduction including more frequent and structured dietetic and/or pharmacotherapeutic interventions.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2065-2072Informations de copyright
© 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.
Références
Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018; 15: 11-20.
Roberts SK, Majeed A, Glenister K, Magliano D, Lubel JS, Bourke L et al. Prevalence of non-alcoholic fatty liver disease in regional Victoria: a prospective population-based study. Med J Aust 2021; 215: 77-82.
Australian Institute of Health and Welfare. Overweight Obesity 2018. https://www.aihw.gov.au/reports-statistics/behaviours-risk-factors/overweight-obesity/data.
Adams LA, Roberts SK, Strasser SI, Mahady SE, Powell E, Estes C et al. Nonalcoholic fatty liver disease burden: Australia, 2019-2030. J Gastroenterol Hepatol 2020; 35: 1628-35.
Ahmed A, Wong RJ, Harrison SA. Nonalcoholic fatty liver disease review: diagnosis, treatment, and outcomes. Clin Gastroenterol Hepatol 2015; 13: 2062-70.
Kaser S, Ebenbichler CF, Tilg H. Pharmacological and non-pharmacological treatment of non-alcoholic fatty liver disease. Int J Clin Pract 2010; 64: 968-83.
Dixon JB, Bhathal PS, O'Brien PE. Weight loss and non-alcoholic fatty liver disease: falls in γ-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg 2006; 16: 1278-86.
Dixon JB, Bhathal PS, Hughes NR, O'Brien PE. Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology 2004; 39: 1647-54.
Furuya CK Jr, De Oliveira CP, De Mello ES, Faintuch J, Raskovski A, Matsuda M et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol 2007; 22: 510-14.
Clark JM, Alkhuraishi AR, Solga SF, Alli P, Diehl AM, Magnuson TH. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res 2005; 13: 1180-6.
Patel AA, Torres DM, Harrison SA. Effect of weight loss on nonalcoholic fatty liver disease. J Clin Gastroenterol 2009; 43: 970-4 (11).
Zachary Z, Brianna F, Brianna L, Garrett P, Jade W, Alyssa D et al. Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obes Res Clin Pract 2020; 14: 210-16 (12).
Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol 2016; 65: 589-600.
Lonardo A, Sookoian S, Pirola CJ, Targher G. Non-alcoholic fatty liver disease and risk of cardiovascular disease. Metabolism 2016; 65: 1136-50.
Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67: 328-57.
Armstrong MJ, Hazlehurst JM, Parker R, Koushiappi E, Mann J, Khan S et al. Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management. QJM Int J Med 2014; 107: 33-41.
Cobbold JF, Raveendran S, Peake CM, Anstee QM, Yee MS, Thursz MR. Piloting a multidisciplinary clinic for the management of non-alcoholic fatty liver disease: initial 5-year experience. Frontline Gastroenterol 2013; 4: 263-9.
Moolla A, Motohashi K, Marjot T, Shard A, Ainsworth M, Gray A et al. A multidisciplinary approach to the management of NAFLD is associated with improvement in markers of liver and cardio-metabolic health. Frontline Gastroenterol 2019; 10: 337-46.
Chen J, Kaur H, Jaques J, Rock Z, Dean CM, Lord RV et al. Association of clinically significant weight loss with number of patient visits and months of attendance at an Australian multidisciplinary weight management clinic. Clin Obesity 2022; 12: e12520.
Lih A, Pereira L, Bishay RH, Zang J, Omari A, Atlantis E et al. A novel multidisciplinary intervention for long-term weight loss and glycaemic control in obese patients with diabetes. J Diabetes Res 2015; 2015: 1-7.
Medveczky DM, Kodsi R, Skelsey K, Grudzinskas K, Bueno F, Ho V et al. Class 3 obesity in a multidisciplinary metabolic weight management program: the effect of preexisting type 2 diabetes on 6-month weight loss. J Diabetes Res 2020; 2020: 1-9.
National Health and Medical Research Council. Clinical practice guidelines for the Management of Overweight and Obesity in adults. Adolescents Children Aust 2013; 16. https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity