Direct access lifestyle training improves liver biochemistry and causes weight loss but uptake is suboptimal in patients with non-alcoholic fatty liver disease.

Objective: To evaluate the uptake and effectiveness of an existing open access lifestyle intervention forged in collaboration between a third sector organisation, funded by local government and a secondary care non-alcoholic fatty liver disease (NAFLD) service in the North West of England. Method: A service outcome evaluation using pre-post comparison design was conducted to analyse changes between baseline clinical health records and 12 week follow up for NAFLD patients who completed the lifestyle intervention. Lifestyle factors, weight loss, changes in alanine aminotransferase (ALT) enzymes and lipid profiles were compared between patients who completed the programme versus 1:1 matched patients who did not. Results: Only 16 of 167 NAFLD patients offered the intervention completed the programme. Intervention patients achieved significant weight loss (-2.3% p ≤ 0.05) over 12 weeks, where the non-intervention group had non-significant weight gain (+0.95%). ALT improved by 20IU/L in the interventional group and 15 IU/L in the non-intervention group; however, this was not statistically different. Conclusion: This study presents first of its kind evaluation of a service collaboration in the UK. Only 1 in 10 patients offered the opportunity completed the programme, a limitation that could affect future strategies. Patient and public involvement research is needed to identify barriers to participation, address adherence issues and identify support mechanisms for lifestyle interventions with NAFLD patients