The impact of clinical pharmacist-led health education on the disease course of non-alcoholic fatty liver disease patients: an interventional study

Abstract

Background: A multitude of health care professionals, including pharmacists, are needed in managing a complex and silent disease like non-alcoholic fatty liver disease (NAFLD) associated with metabolic syndrome (MetS). These health care professionals can increase patients’ health awareness regarding the prevention and the management of the disease. The current study aimed to evaluate the impact of clinical pharmacist education, counseling and follow up on the management of NAFLD with MetS. Methods: This study recruited 102 patients with NAFLD and MetS. Participants received regular health education sessions concerning the disease and recommended lifestyle (diet and exercise) and were followed by clinical pharmacist for 6 months. At the end of the study, participants were divided into two groups; those compliant with education and follow up session (compliant group; n=61); and those attending > 60% but not completing whole sessions (non-compliant group; n=41). Anthropometric measures, liver function, lipid profile, homeostasis model of assessment-insulin resistance (HOMA-IR), biochemical NAFLD score, radiological liver steatosis and fibrosis grade changes were recorded at baseline and endpoint. Results: The compliant group showed a more significant decrease in weight (p=0.003), low density lipoprotein (LDL) (p=0.009), and very LDL (p<0.001), and a more significant increase in high density lipoprotein (HDL) (p=0.010) compared with the non-compliant group. Moreover, the compliant group showed a statistically significant higher number of patients achieving normalization of total cholesterol (p=0.002), HDL (p=0.004), waist circumference (p=0.004), improvement of body mass index category (p=0.008), liver steatosis grade (p=0.009), liver fibrosis grade (p<0.001), and absence of dyspeptic symptoms (p=0.0010) and hepatomegaly (p= 0.027) compared with the non-compliant group. Fasting blood glucose (p=0.209), fasting insulin (p=0.179), and HOMA-IR score (p=0.193) showed non-significant difference between both groups at endpoint. Conclusion: The educational intervention of a clinical pharmacist showed significant positive impact on ameliorating metabolic syndrome parameters and achieving desired NAFLD therapeutic outcomes.