Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is tightly associated with insulin resistance and type 2 diabetes (T2DM), both risk factors for disease progression, liver failure and cardiovascular complications. A multidisciplinary approach involving hepatologists and diabetologists working alongside allied health professionals is thus advocated for the management of NAFLD. Interventions delivered include dietary and lifestyle advice as well as pharmacological interventions for cardiovascular disease and diabetes. Objective evaluation of this multidisciplinary intervention on liver and cardio-metabolic health is currently limited.
Objective: This retrospective study aimed to determine the impact of a large tertiary multidisciplinary NAFLD clinic on liver and cardiovascular disease risk factors using both clinical and surrogate markers of metabolic syndrome, cardiovascular risk and liver disease between 2014-17.
Results: 186 patients with NAFLD and without other hepatic co-morbidities were followed from referral until their latest review. Patients were followed for a median of 13.5 months (235). 30% had confirmed liver cirrhosis and 60% had T2DM at baseline. Median alanine aminotransferase (ALT) fell significantly (50IU/l to 39IU/l; −22%, P<0.0001) from baseline to follow-up. Similarly, median weight reduced significantly by 3.9 kg (−3.9%, P<0.0001), as did total cholesterol (−0.6 mmol/l; −11.8%, P=0.0092). Median HbA1c fell 4 mmol/mol (−4.2%, P=0.0009) in the total cohort; reduction was most marked in patients with poorly controlled diabetes (HbA1c >58 mmol/mol at baseline: −14.5 mmol/mol; −19.0%, P<0.0001). Median liver stiffness measured using transient elastography, a non-invasive measure of liver fibrosis, showed a significant reduction of 1.9 kPa (−20%, P=0.0069).
Conclusion: Our results demonstrate that patients managed through a multidisciplinary metabolic hepatology clinic exhibit significant improvements in measures of liver and cardio-metabolic health. Patients with poorly controlled T2DM, who may be at greatest risk of liver disease progression, demonstrated the largest improvement in HbA1c of 14.5 mml/mol (>1%HbA1c), a reduction well known to reduce diabetes complications. This may potentially also confer good benefit in slowing NAFLD progression.