P17 Do NAFLD patients engage with additional weight management support between appointments

Background and Aim With the exponential increase in diagnosis of non-alcoholic fatty liver disease (NAFLD) in children and young people (CYP) in the UK, the numbers of CYP attending tertiary NAFLD clinics continues to rise. Though there is no convincing evidence that pharmacological therapy can halt or reverse disease, there is strong evidence that 5–10% weight loss can improve or reverse the condition. From a liver surveillance perspective, appointments with bloods and imaging every 6–12 months are deemed sufficient, but are not adequate to support diet and lifestyle changes. The purpose of this study was to determine whether patients and their parents/carers engaged with input between appointments, and whether it improved weight loss. Subjects and Methods All patients who attended NAFLD clinic requiring weight management support (January - August 2018) were offered follow up between appointments. A phone call or email was sent within six weeks of the appointment. Where phone calls were unanswered a message was left, and a letter sent if no answering service. If there was no response, no further contact attempts were made. Clinical, biochemical and anthropometric data were collected on all CYP who attended clinic; patients were reviewed 6–12 monthly. Diagnosis of NAFLD was made by paediatric hepatologist with biopsy or a combination of radiological and biochemical data on exclusion of all other known causes of liver disease. CYP were excluded if they attended another dietetic service regularly, were achieving sufficient weight loss, or weight management was not the primary reason for review. Body mass index (BMI) was calculated and converted to z-scores (WHO criteria). Results During the study period 33 CYP (11F) were offered additional follow up; all agreed. Mean (SD) age was 15.0(2.15) years at initial appointment. A phone call was requested by 17(52%) and 16(48%) preferred email. Contact was made with the parent/carer in 19 cases (58%) and 14(42%) directly with the CYP. Contact was made with 15(45%), nine (60%) by phone and six (40%) by email. Of those who received additional follow up five (33%) had a second contact and one (3%) a third contact. Mean (SD) follow up time was 37.9(2.41) weeks. For the 24(73%) patients with both initial and follow up data, mean (SD) BMI z-score at initial appointment was 3.19(0.53) and follow up 3.23(0.62). There was no difference between responders/non-responders in BMI z-score change. Summary and Conclusions Although all the CYP agreed to have additional follow up, only 45% responded. The preference for contact was via phone and with parent/carer. A limitation was that only one attempt was made to reach each patient; messages may not have been received. As the initial response to more regular follow up was positive, consideration should be made to whether a pre-arranged phone clinic would be more suitable. Future research could focus on reasons why CYP/their families are reluctant to engage, and ways to empower CYP to change. To pave the way forward a patient questionnaire evaluating the current service and seeking opinions regarding regular, remote follow up would be valuable.