Barriers and Facilitators to Mediterranean Diet Adoption by Patients With Nonalcoholic Fatty Liver Disease in Northern Europe

Abstract

Dietary interventions for weight loss are effective therapies for nonalcoholic fatty liver disease (NAFLD). The Mediterranean diet might benefit these patients, but it is not followed consistently in Northern European countries. We examined factors that determine Mediterranean diet adoption and maintenance in a northern European population. METHODS:We used a mixed-methods approach to investigate the effects of a 12-week Mediterranean diet intervention and perceived barriers and facilitators. Nineteen adults with NAFLD were recruited from a tertiary hepatology center in England. Participants were taught behavioral strategies through the provision of shopping lists, meal planners, and recipes; no advice was given on calorie allowances or physical activities. We used the 14-point Mediterranean diet assessment tool to assess dietary intake, based on a small number of foods in servings per day or servings per week, at baseline and after 12 weeks; participants were assigned scores of low (<5 points), moderate (6-9 points), or high (10-14 points). Semistructured interviews were audiorecorded, transcribed, and analyzed using the framework method. RESULTS:Twelve weeks after the dietary advice, Mediterranean diet adoption significantly increased from moderate to high (mean increase, 2.2 points; from 7.6 -2.5 at baseline to 9.8 -2.8 at 12 wk) (P [ .006). This increase was associated with a mean reduction in body weight of 2.4 kg (from 99.2 -17.0 kg at baseline to 96.8 -17.5 kg at 12 wk) (P [ .001) and increased serum concentrations of high-density lipoprotein cholesterol in 72% of participants (from 1.10 -0.8 at baseline to 1.20 -1.30 vs 1.00 -0.5 at 12 wk) (P [ .009). Increased nutrition knowledge and skills, family support, Mediterranean diet promotion in media and clinical settings, and nutritional care facilitated diet changes. Barriers to Mediterranean diet uptake included an obesogenic environment, life stressors, and demand for convenience. Poor understanding of the causes and significance of NAFLD adversely affected readiness to change dietary habits. CONCLUSIONS:In an analysis of patients with NAFLD in the northern United Kingdom, we found a 12-week Mediterranean diet intervention was acceptable and associated with significant reductions in body weight and increased serum levels of high-density lipoprotein. We identified barriers and facilitators that could support appropriate treatment adaptations and guide personalized intervention approaches.

Feasibility of a Very Low Calorie Diet to Achieve a Sustainable 10% Weight Loss in Patients With Nonalcoholic Fatty Liver Disease

“…those embarking on a VLCD for T2DM). This is largely because NAFLD is less well understood by patients and does not raise the same level of concern ( 37 – 39 ). To date, the use, acceptability, and feasibility of the VLCD with patients with NAFLD has not been explored.…”

Lifestyle modification in NAFLD/NASH: Facts and figures

“…A lack of understanding and acknowledgement of the link between current lifestyle habits and their NAFLD/NASH will hinder any meaningful change -patients need to understand that NAFLD/ NASH is potentially reversible if they make and sustain these changes. 106,[109][110][111] There are multiple behaviour change techniques (BCTs) that have been shown to be effective in the management of patients with chronic diseases. [112][113][114] These BCTs aid clinicians to support patients in making informed decisions about their behaviour(s) and encourage patients to take a level of responsibility for their own health.…”

Mediterranean Diet and NAFLD: What We Know and Questions That Still Need to Be Answered

“…A variety of dietary patterns have been proposed for NAFLD-treatment but no pattern has adequately been evaluated in randomized controlled trials in large cohorts of patients. However, the Mediterranean diet (MD) may reasonably be an effective and easily reproducible diet pattern, as it is characterized by a balanced composition of macronutrients which have positive effects on NAFLD that can be found in foods from different areas in the world [10][11][12]. The MD has indeed been recently recommended as the diet of choice for the treatment of NAFLD by the EASL-EASD-EASO Clinical Practice Guidelines as it improves metabolism, in particular through a reduction of insulin-resistance and lipid serum concentrations, and it induces a regression of steatosis and a significant reduction of cardio-vascular events [3,[13][14][15][16][17].…”