Changing healthcare through patient-led research: a trainee’s story
A recent study conducted by Newcastle BRC’s Liver Disease theme PhD student, Jadine Scragg, and supervised by NIHR Clinical Lecturer, Dr Kate Hallsworth has showed that delivery of a very low calorie diet (VLCD) is feasible, acceptable and a potential treatment option for some individuals living with Non-alcoholic Fatty Liver Disease (NAFLD). Jadine gives us more information about this study, and how patient involvement was key in its success.
Can you give us a summary of your research?
My research has primarily focused on lifestyle behavioural interventions for the treatment and management of liver disease. The main branch of my research has been assessing the feasibility and acceptability of a VLCD (800kcal/day) to achieve a sustained significant weight loss in patients with advanced non-alcoholic fatty liver disease. This was hugely successful; I found that patients were highly motivated to take part and their adherence to the very challenging intervention was fantastic; significant, sustained weight loss was achieved by the majority of patients who took part. The study was fully recruited (n=30) within six months and throughout the VLCD phase of the intervention, we only had three patients withdraw. Overall, we identified that a VLCD is a feasible and acceptable intervention to achieve significant weight loss in patients with advanced NAFLD.
What kind of changes would your research make possible for healthcare?
The nature of my research is widely translational, which means what we learn through the study can be directly applied to patients routines to improve their lives on a day-to-day level. There are no approved medications for patients with NAFLD, and previously they will have simply been told to lose weight, but received little support in doing so. The feasibility of a VLCD for these patients represents one of the first interventions that is specifically targeted towards this cohort, and provides clinicians with a tool that can be used to combat the rising prevalence of NAFLD. Furthermore, we observed added improvement in measures relating to cardiovascular and metabolic disease risk, and therefore our patients experienced a global improvement in their health. For example, 16 out of 30 participants at baseline had been diagnosed with type 2 diabetes, over 33% were prescribed statins and/or antihypertensive medication and most reported experiencing a lower quality of life due to their weight related symptoms. This therefore suggest that the implementation of a VLCD in clinical for patients with NAFLD would provide clinicians with a tool that therefore may be used to target other diseases and multimorbidity; subsequently reducing costs to the NHS through fewer GP visits, hospital stays and prescribed medications.
How important was the participation of patients in your research?
This was of huge importance to my study. Recruitment was carried out through weekly clinics at the Freeman Hospital and CRESTA, where eligible patients living with advanced NAFLD were approached to take part. Firstly, during recruitment we invited patients to bring relevant friends or family with them to the screening visit; we identified early on that social support would be critical towards the successfully adherence towards the intervention. Throughout the study, participants were invited to bring their friends/ family to study visits. Arguably, the most important part of every study visit were the discussions with the participants to assess how they were finding the intervention and to identify and overcome any barriers that they might be experiencing. Given that this study was the first of its kind in patients with NAFLD, we found this regular feedback from the patients to be really useful, and allowed us to share tips between participants.
Did your study involve any links with industry?
I am incredibly grateful to Nestle Health Science; they provided the meal replacement products for the duration of the study, free of charge. We developed a great collaborative relationship where I kept them up to date with the status of the study, and we worked together to ensure the correct amounts of meal replacement products were delivered at the correct time.
What have you gained from being an NIHR-funded trainee?
It’s been an incredible experience being an NIHR trainee. I’ve had access to so many workshops which have developed my skills as a researcher. For example, I’ve been fortunate to attend workshops on lay writing, 3-minute thesis skills and effective PPI, to name just a few. I’ve found that the NIHR has been incredibly supportive, particularly over the recent challenging months with COVID-19, and it’s been an incredible resource for me to network and meet other researchers from different themes and backgrounds. This has allowed me to exchange skills and develop my research portfolio, as well as receiving feedback from those who I otherwise would not. That in particular has been hugely useful in advance of presenting my data at conferences, and while writing up manuscripts.
What are your next steps?
I’m excited about the next steps of my career. Currently I’m finalising my thesis, and have been working on some exciting manuscripts. Going forward, I would love to further explore the use of a VLCD and/or other lifestyle interventions as a means to treat NAFLD. I’m proud of my study and I am confident that it’s take home messages can have a huge impact on a huge proportion of patients, and I am aiming to spread that message and raise awareness about the dangers of NAFLD and the benefits of lifestyle interventions as therapy.