Title: Delivering the first evidence based lifestyle service pathway for people with non-alcoholic fatty liver disease (NAFLD)
Funder: Health Education England

Abstract: Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver conditions ranging from hepatic steatosis through steatohepatitis to cirrhosis. Its prevalence has been estimated at between 1 in 5 and 1 in 3 of the adult population depending on country and diagnostic criteria used. Prevalence increases with degree of obesity, and is very common in those with Type 2 diabetes. Rising prevalence of obesity and Type 2 diabetes, particularly in younger people, will ensure that NAFLD remains a growing clinical concern for the future. Lifestyle modification, which encompasses diet, weight loss, physical activity, and/or exercise related behaviours, is the primary recommended therapy for NAFLD, especially in the absence of approved pharmaceutical agents. Despite the prevalence and importance of NAFLD in developing more advanced clinical presentations, pathways for the clinical management of NAFLD are poorly defined. The lack of a defined care pathway essentially leaves patients unsupported until they present with more advanced conditions before they are actively engaged in care.This research will define the current lived experience for people diagnosed with NAFLD and their care teams, both in Primary and Secondary Care. Furthermore, the treatment algorithms and treatment trajectory (i.e. who gets referred to Secondary Care and how the condition is monitored) will be defined alongside how patients perceive the condition / service and feel about the care pathway.On this foundation, I will refine the service pathway for people with NAFLD by actively engaging patients and healthcare professionals to deliver a streamlined and practical service pathway based on current evidence for disease management. The focus of this refinement will be on the delivery of lifestyle interventions. Refining this service will involve creating new tools to aid service delivery which will be developed with all relevant stakeholders (to include patients, medics, nurses, allied health professionals (AHPs) and exercise specialists) to allow a consistent approach to disease management. This research will deliver patient benefit by creating a new lifestyle service which has been developed and designed in consultation with both patients and care teams. By doing so this pathway will, for the first time, deliver a consistent level of care across the NHS, regardless of whether they are being managed in Primary or Secondary Care for patients with NAFLD. Healthcare professionals will also be able to provide lifestyle interventions based on the most up-to-date scientific evidence and will have extensive knowledge with regards to the supporting infrastructure/services available in the area to support physical activity/exercise. This service, if proven to be effective, could not only potentially create a step change in the management of NAFLD but also in the prevention of conditions associated with NAFLD such as Type 2 diabetes and cardiovascular disease.

Lay abstract: NAFLD affects up to 1 in 3 adults in the UK. It is a key marker for the development of cardiovascular disease and Type 2 diabetes. Despite its prevalence and importance, there is no agreed care pathway for NAFLD in the NHS. This Lectureship will define the current lived experiences of people with NAFLD and their care teams. An experience based design approach will be used to develop and refine the care pathway, with a particular focus on lifestyle. Combined this Lectureship will deliver the first lifestyle care pathway in NAFLD and establish the feasibility of use within the NHS.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: ORAL AND GASTROINTESTINAL