PMID- 31682643 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2041-4137 (Print) IS - 2041-4145 (Electronic) IS - 2041-4137 (Linking) VI - 10 IP - 4 DP - 2019 Oct TI - A multidisciplinary approach to the management of NAFLD is associated with improvement in markers of liver and cardio-metabolic health. PG - 337-346 LID - 10.1136/flgastro-2018-101155 [doi] AB - 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. CI - (c) Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Moolla, Ahmad AU - Moolla A AUID- ORCID: 0000-0001-5305-0747 AD - Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK. AD - National Institutes of Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. FAU - Motohashi, Kenzo AU - Motohashi K AD - Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK. FAU - Marjot, Thomas AU - Marjot T AUID- ORCID: 0000-0002-6542-6323 AD - Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK. AD - Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. FAU - Shard, Amelia AU - Shard A AD - Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. FAU - Ainsworth, Mark AU - Ainsworth M AD - Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. FAU - Gray, Alastair AU - Gray A AD - Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK. FAU - Holman, Rury AU - Holman R AD - National Institutes of Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. AD - Diabetes Trial Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK. FAU - Pavlides, Michael AU - Pavlides M AD - National Institutes of Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. AD - Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. FAU - Ryan, John D AU - Ryan JD AD - National Institutes of Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. AD - Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. FAU - Tomlinson, Jeremy W AU - Tomlinson JW AD - Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK. AD - National Institutes of Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. FAU - Cobbold, Jeremy F AU - Cobbold JF AD - National Institutes of Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. AD - Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. LA - eng PT - Journal Article DEP - 20190430 PL - England TA - Frontline Gastroenterol JT - Frontline gastroenterology JID - 101528589 CIN - doi: 10.1136/flgastro-2019-101235 PMC - PMC6788125 OTO - NOTNLM OT - diabetes mellitus OT - economic evaluation OT - fatty liver OT - non-alcoholic steatohepatitis COIS- Competing interests: JFC and JT have received consultancy fees from Novo Nordisk. JFC has received speaker fees from Intercept Pharmaceuticals. EDAT- 2019/11/05 06:00 MHDA- 2019/11/05 06:01 PMCR- 2020/10/01 CRDT- 2019/11/05 06:00 PHST- 2018/11/28 00:00 [received] PHST- 2019/03/21 00:00 [revised] PHST- 2019/04/07 00:00 [accepted] PHST- 2019/11/05 06:00 [entrez] PHST- 2019/11/05 06:00 [pubmed] PHST- 2019/11/05 06:01 [medline] PHST- 2020/10/01 00:00 [pmc-release] AID - flgastro-2018-101155 [pii] AID - 10.1136/flgastro-2018-101155 [doi] PST - ppublish SO - Frontline Gastroenterol. 2019 Oct;10(4):337-346. doi: 10.1136/flgastro-2018-101155. Epub 2019 Apr 30.