Tryon, Lilly

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Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. The main risk factor for the development of NAFLD is metabolic syndrome. Women are at greatest risk, typically in their 5th to 6th decade of life. The more aggressive form of NAFLD is nonalcoholic steatohepatitis (NASH) which is characterized by inflammation associated with NAFLD. NASH has the greatest tendency to progress into cirrhosis. However, lifestyle intervention has been shown to effectively treat, and even reverse NAFLD. The purpose of this quantitative, quasi-experimental study was to lend additional research and demonstrate improvement in NAFLD through lifestyle intervention with 1) a Mediterranean diet, high in fiber and low in saturated fat, 2) moderate exercise with walking 90 minutes per week, and 3) social support group meetings once monthly over a six-month period. Outcomes were measured by 1) 5% total body weight (TBW) loss, 2) improved hepatic steatosis as measured by ultrasound, and 3) improved serum fibrosis staging. There were 20 participants, with a mean age of 53.55 years. Participants were 85% female, 15% male, 85% Caucasian, 10% African American, and 5% Hispanic. They received education on a Mediterranean diet, agreed to walk 90 minutes each week, and attended six support group meetings over a six-month period. At the end of six months, 90% of participants achieved 5% TBW loss. Diet adherence was shown to be statistically significant to the prediction of percentage of TBW loss. However, walking and group meeting attendance were not statistically significant to the prediction of percentage of TBW loss. With regard to ultrasound outcomes, diet and walking adherence were not found to be statistically significant; still, diet adherence was noted to make a person 1.75 times more likely to have a positive ultrasound outcome, with improved fibrosis. Improved post-intervention serum fibrosis scores were found to be statistically significant. After careful SCHOLARLY PROJECT 4

consideration, the greatest limitation of this study was size. This study was too small to accurately measure the power of all of the independent variables and their impact on NAFLD. Future studies should include a larger, more diverse population, and be conducted over a longer period of time. Future studies would also benefit from a multi-disciplinary team approach. Despite the limitations, the knowledge gained from this research will help shape and advance current clinical guidelines. Nurse Practitioners (NPs) serve as leaders in lifestyle medicine. NPs are vital to advancing research and studying the impact lifestyle medicine has on chronic disease, such as NAFLD.

Keywords: NAFLD, NASH, fibrosis, cirrhosis, exercise, diet, social support in treatment of chronic disease, weight loss, metabolic syndrome, T2DM, dietary modification, Mediterranean diet, hyperlipidemia and liver disease, lifestyle modification, lifestyle medicine, diagnosis, and treatment of NAFLD