Nutrition and Dietetics Department, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
Br J Nutr. 2022 Oct 14;128(7):1220-1230. doi: 10.1017/S0007114521001100. Epub 2021 Mar 26.
Practice guidelines for non-alcoholic fatty liver disease (NAFLD) recommend promoting the Mediterranean dietary pattern (MDP) which is cardioprotective and may improve hepatic steatosis. This study aimed to explore multidisciplinary clinicians' perspectives on whether the MDP is recommended in routine management of NAFLD and barriers and facilitators to its implementation in a multi-ethnic setting. Semi-structured individual interviews were conducted with fourteen clinicians (seven doctors, three nurses, three dietitians and one exercise physiologist) routinely managing patients with NAFLD in metropolitan hospital outpatient clinics in Australia. Interviews were audio-recorded, transcribed and analysed using thematic content analysis. Clinicians described that lifestyle modification was their primary treatment for NAFLD and promoting diet was recognised as everyone's role, whereby doctors and nurses raise awareness and dietitians provide individualisation. The MDP was regarded as the most evidence-based diet choice currently and was frequently recommended in routine care. Facilitators to MDP implementation in practice were: improvement in diet quality as a parallel goal to weight loss; in-depth knowledge of the dietary pattern; access to patient education and monitoring resources and; service culture, including an interdisciplinary clinic goal, and knowledge sharing from expert dietitians. Barriers included perceived challenges for patients from diverse cultural and socio-economic backgrounds and limited clinician training, time and resourcing to support behaviour change. Integration of MDP in routine management of NAFLD in specialist clinics was facilitated by a focus on diet quality, knowledge sharing, belief in evidence and an interdisciplinary team. Innovations to service delivery could better support and empower patients to change dietary behaviour long-term.
非酒精性脂肪性肝病（NAFLD）实践指南建议推广地中海饮食模式（MDP），该模式对心脏有保护作用，并可能改善肝脂肪变性。本研究旨在探讨多学科临床医生对 MDP 是否应在 NAFLD 的常规管理中推荐，以及在多民族环境中实施 MDP 的障碍和促进因素。对澳大利亚大都市医院门诊常规管理 NAFLD 的 14 名临床医生（7 名医生、3 名护士、3 名营养师和 1 名运动生理学家）进行了半结构化的个人访谈。访谈以音频形式记录，转录后采用主题内容分析法进行分析。临床医生描述说，生活方式改变是他们治疗 NAFLD 的主要方法，促进饮食被认为是每个人的职责，医生和护士提高认识，营养师提供个性化建议。MDP 目前被认为是最有循证医学依据的饮食选择，在常规护理中经常被推荐。实践中 MDP 实施的促进因素包括：改善饮食质量作为减肥的平行目标；深入了解饮食模式；获得患者教育和监测资源；服务文化，包括跨学科诊所目标，以及从专家营养师那里获得知识共享。障碍包括来自不同文化和社会经济背景的患者的感知挑战，以及临床医生培训、时间和资源有限，无法支持行为改变。在专家诊所中，将 MDP 纳入 NAFLD 的常规管理中，通过关注饮食质量、知识共享、对证据的信任和跨学科团队，使 MDP 的整合变得更加容易。服务提供的创新可以更好地支持和授权患者长期改变饮食行为。
