Lifestyle as Therapy in Liver Disease
This feasibility study aims to assess the proposed recruitment strategies in a well-defined patient group with advanced Non-alcoholic fatty liver disease (NAFLD) and will determine whether an 8-week very low calorie diet (VLCD) is an acceptable weight loss intervention to be used in patients with NAFLD.
Liver disease is the fifth biggest killer in the UK and is the only ‘big killer’ that is growing in prevalence each year. NAFLD affects up to 1-in-3 adults and is currently the most common liver disease worldwide, and is directly related to a sedentary lifestyle, obesity and chronic excess calorie consumption. Approximately 40% of NAFLD patients will develop progressive liver fibrosis and ultimately up to 11% will develop end stage liver disease. Due to this increasing epidemic, it is estimated that by 2020 NAFLD will be the primary indication for liver transplantation. Currently the main treatment for NAFLD is weight loss, but patients often find this difficult to achieve and current recommendations are vague on how best to support patients in losing weight.
A very low calorie diet (VLCD) approach has been demonstrated as a suitable method for inducing weight-loss, and reducing liver fat in people with Type 2 diabetes. To date, this hasn’t been assessed in NAFLD. Therefore, I will be investigating the feasibility of an 8-week VLCD (800kcals/ day) intervention for NAFLD, followed by a 6-month period where patients will aim to maintain weight loss.
As NAFLD approaches end stage liver disease, often the only viable treatment is liver transplant. The number of people waiting for a liver transplant is increasing in the UK and cardiorespiratory fitness has been indicated as an independent indicator of postoperative mortality. In light of this, I will be developing an exercise programme as an intervention for those currently on the transplant waiting list to target cardiorespiratory fitness and muscular strength, with the hope that this will in turn improve postoperative outcomes. This intervention will be designed following insights from patients and health care practitioners (HCPs), with a goal of maximising adherence.