Factors associated with uptake and adherence to a VLCD in non-alcoholic fatty liver disease patients

Background: Clinical guidelines recommend weight loss to manage non-alcoholic fatty liver disease (NAFLD). However, the majority of patients find dietary behaviour change to initiate and sustain weight loss a significant challenge. We identified factors associated with uptake and adherence to a very low calorie diet (VLCD) to manage NAFLD.
Methods: 23 patients with advanced NAFLD who were enrolled in a VLCD (~800 kcal/day) took part in a qualitative interview. Interviews were audio recorded, transcribed verbatim and thematically analysed.
Findings: Five main themes were identified. A desire to achieve rapid weight loss to improve liver health and prevent disease progression was the most salient facilitator to uptake. Early and significant weight loss; accountability to clinicians; personalised feedback and the desire to receive positive reinforcement from a consultant were facilitators to adherence. Practical and emotional support from friends and family members were important for self-regulation. Irregular working patterns that prevented attendance at appointments were barriers to adherence and completion of the intervention.
Discussion: Uptake and adherence to a VLCD in patients with advanced NAFLD relies on early and rapid weight loss. Personalised feedback and positive reinforcement in the clinical setting combined with ongoing social and practical support from friends and family members is important for self-regulation. Findings support those identified in patients with type 2 diabetes using a VLCD to achieve diabetes remission and highlight the importance of intensive behavioural support during the early stages of dietary behaviour change using a VLCD approach.