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Papers by Graeme Macdonald
Obesity Research & Clinical Practice, 2019
Digestive Diseases and Sciences
BACKGROUND Background: The metabolic syndrome (MetS) is common across many complex chronic diseas... more BACKGROUND Background: The metabolic syndrome (MetS) is common across many complex chronic disease groups. Advances in health technology have provided opportunities to support lifestyle interventions. Implementation of health technology driven services in a tertiary setting remains untested. OBJECTIVE The purpose of this study is to test the feasibility of a health technology-assisted lifestyle intervention in a patient-led model of care. METHODS Methods: The study is a single-centre, 26-week randomised controlled trial. The setting is specialist kidney and liver disease clinics at a large Australian tertiary hospital. The participants will be adults with a complex chronic condition who are referred for dietetic assessment and display at least one feature of the MetS. All participants will receive an individualised assessment and advice on diet quality from a dietitian, a wearable activity monitor and standard care. Participants randomised to the intervention group will receive acce...
Obesity Research & Clinical Practice, 2019
Journal of Gastroenterology and Hepatology, 2018
Progress in Transplantation, 2021
Introduction Solid organ transplant recipients experience greater cardiometabolic risk than the g... more Introduction Solid organ transplant recipients experience greater cardiometabolic risk than the general population. Following a Mediterranean dietary pattern has been shown to reduce cardiometabolic risk. This study aimed to assess multidisciplinary clinician perspectives of routine nutrition care for kidney and liver transplant recipients and barriers and enablers to implementation of the Mediterranean dietary pattern. Methods Semi-structured individual interviews were conducted with clinicians in a metropolitan health service at tertiary/quaternary transplant centres involved in longer-term management of kidney and liver transplants recipients. Audio-recorded interviews were transcribed verbatim and analysed using thematic content analysis. Findings Nineteen clinicians (9 medical officers, 5 dietitians, 3 nurses and 2 other allied health professionals) were interviewed. Four themes with 11 subthemes were identified: the Mediterranean dietary pattern is not part of routine care (th...
Journal of Telemedicine and Telecare, 2020
Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk fac... more Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25–68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) ‘broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face c...
Annals of Hepatology, 2009
Nutrition & Dietetics, 2019
AimInterventions to prevent excessive weight gain after liver transplant are needed. The purpose ... more AimInterventions to prevent excessive weight gain after liver transplant are needed. The purpose of the present study was to enhance a specialist post‐transplant well‐being program through knowledge exchange with end‐users.MethodsThe study used an interactive process of knowledge exchange between researchers, clinicians and health system users. Data were collected as focus groups or telephone interviews and underwent applied thematic analysis.ResultsThere were 28 participants (age 24–68 years; 64% male). The results identified experiences that may influence decisions around health behaviours during the course of transplant recovery. Three over‐arching themes were identified that impact on liver transplant recipients post‐transplant health behaviours. These include (i) Finding a coping mechanism which highlighted the need to acknowledge the significant emotional burden of transplant prior to addressing long‐term physical wellness; (ii) Back to Life encompassing the desire to return t...
Current Hepatology Reports, 2017
Hepatobiliary surgery and nutrition, 2017
Cardiometabolic risk factors are increasing in liver transplant recipients (LTR). Influencing die... more Cardiometabolic risk factors are increasing in liver transplant recipients (LTR). Influencing dietary factors have not been assessed. The aim of this observational study was to assess changes in weight, metabolic function, dietary intake and eating behaviours in the first year after orthotopic liver transplantation (OLT). Consecutive recruitment of 17 patients (14 males) awaiting OLT at a single tertiary hospital. Dietary intake, food behaviours and anthropometry were recorded at baseline, and 6 and 12 months post-transplant. By 12 months, patients had gained on average 7.3% of body weight. The prevalence of overweight or obesity increased from baseline 53% to 77% (P=0.001). By 6 months, 65% (n=11/17) of patients had altered glucose metabolism. Dietary intake was consistent with a Western-style dietary pattern with high saturated fat. Over half of the patients (69%, n=11/16) reported low to no depressive feelings and rated their self-esteem as good (53%, n=9/16). The Power of Food S...
Liver international : official journal of the International Association for the Study of the Liver, Dec 5, 2017
Research in NAFLD management is commonly based on quantitative assessment of liver fat by proton-... more Research in NAFLD management is commonly based on quantitative assessment of liver fat by proton-magnetic resonance spectroscopy ((1) H-MRS), and translation of this into clinical practice is currently limited by availability and expense. Novel steatosis biomarkers have been proposed for the prediction of liver fatness; however, whether these are suitable for detecting changes in liver fat is unknown. We aimed to determine the accuracy of these indices, and waist circumference (WC), in quantifying longitudinal change in (1) H-MRS-quantified liver fat. We performed a secondary analysis using data from 97 overweight/obese adults (age: 39.7±11.5 years, body mass index: 30.7±4.4 kg/m(2) , liver fat: 6.0±4.8%, 65% male) who completed either an 8-week exercise or 12-week nutraceutical intervention, with varying degrees of change in liver fat. Baseline and post-intervention measures were liver fat ((1) H-MRS), NAFLD Liver Fat Score, Liver Fat Equation (LFE), Fatty Liver Index (FLI), Hepati...
World Journal of Hepatology, 2016
ABSTRACT Hepatitis C virus (HCV) is a major cause of chronic liver disease that may progress to c... more ABSTRACT Hepatitis C virus (HCV) is a major cause of chronic liver disease that may progress to cirrhosis. Antiviral treatment is successful in less than 50% of patients, is costly and causes debilitating side effects. For these reasons, additional therapies to limit the progression of liver disease are urgently required. Steatosis is found in 60% of patients with HCV and is strongly associated with more severe fibrosis. Improvements in biochemical parameters may be seen with weight reduction, however the effects on liver histology have not been investigated. We propose that in patients with chronic HCV and steatosis, obesity contributes to fat in the liver, which results in increased fibrosis and progression to cirrhosis. This study investigated the effect of weight reduction on liver biochemistry and histology in patients with HCV and the success of weight maintenance after an intensive intervention. We examined the effect of a 12 week diet and exercise program where all subjects were seen weekly by the Dietician, with the goal of achieving a 0.5 kg weight loss per week. Biochemistry was monitored monthly and a liver biopsy was performed prior to and 3-6 months after the intervention period. Patients then entered a 12 month weight maintenance program with monthly dietetic review. After 12 weeks there was a mean weight loss of 5.9 ± 3.2 kg and a mean reduction in waist circumference of 9.0 ± 5.0 cm. In 16 of the 19 patients, serum ALT levels fell progressively with weight loss. Mean fasting insulin fell from 16 to 11 mmol/L (p<0.002). Nine of the 10 patients with paired liver biopsies had a reduction in steatosis. The degree of reduction in steatosis was significantly associated with the percentage of weight loss (p=0.005). In these subjects the median fibrosis score decreased from 3 to 1 (p=0.01) To date, 12 patients have completed 6-12 months of the maintenance program with a 55% success rate. Those that have maintained weight have sustained improvements in their liver function. A small amount of weight loss may be associated with a reduction in steatosis and abnormal liver enzymes and an improvement in fibrosis, despite the persistence of the virus.
Applied Physiology, Nutrition, and Metabolism, 2014
Maximal fat oxidation (MFO), as well as the exercise intensity at which it occurs (Fatmax), have ... more Maximal fat oxidation (MFO), as well as the exercise intensity at which it occurs (Fatmax), have been reported as lower in sedentary overweight individuals but have not been studied in trained overweight individuals. The aim of this study was to compare Fatmax and MFO in lean and overweight recreationally trained males matched for cardiorespiratory fitness (CRF) and to study the relationships between these variables, anthropometric characteristics, and CRF. Twelve recreationally trained overweight (high fatness (HiFat) group, 30.0% ± 5.3% body fat) and 12 lean males (low fatness (LoFat), 17.2% ± 5.7% body fat) matched for CRF (maximal oxygen consumption (V̇O2max) 39.0 ± 5.5 vs. 41.4 ± 7.6 mL·kg–1·min–1, p = 0.31) and age (p = 0.93) performed a graded exercise test on a cycle ergometer. V̇O2max and fat and carbohydrate oxidation rates were determined using indirect calorimetry; Fatmax and MFO were determined with a mathematical model (SIN); and % body fat was assessed by air displace...
Liver International, 2012
BackgroundSerum hepcidin concentration is potentially affected by inflammation and iron stores in... more BackgroundSerum hepcidin concentration is potentially affected by inflammation and iron stores in chronic liver disease (CLD), but little is known about the relationship between hepcidin and the degree of hepatic fibrosis. We investigated the potential role of serum hepcidin as a biomarker of advanced liver disease.MethodsSerum hepcidin was measured in 332 adults with CLD of varying aetiologies, 45 healthy and 50 non‐liver disease patient controls. Liver biopsy data were available for 228 CLD subjects.ResultsHepcidin was decreased in CLD patients compared with non‐liver disease patient controls (P < 0.0001) but not healthy controls, and was lowest in those with cirrhosis (P < 0.0001). Serum hepcidin correlated with hepatic hepcidin mRNA expression in 91 biopsy samples available for genetic analysis (r = 0.68, P < 0.0001). Hepcidin also correlated positively with serum ferritin concentration, transferrin saturation, ALT, serum albumin and haemoglobin, but negatively with ser...
Obesity Research & Clinical Practice, 2019
Digestive Diseases and Sciences
BACKGROUND Background: The metabolic syndrome (MetS) is common across many complex chronic diseas... more BACKGROUND Background: The metabolic syndrome (MetS) is common across many complex chronic disease groups. Advances in health technology have provided opportunities to support lifestyle interventions. Implementation of health technology driven services in a tertiary setting remains untested. OBJECTIVE The purpose of this study is to test the feasibility of a health technology-assisted lifestyle intervention in a patient-led model of care. METHODS Methods: The study is a single-centre, 26-week randomised controlled trial. The setting is specialist kidney and liver disease clinics at a large Australian tertiary hospital. The participants will be adults with a complex chronic condition who are referred for dietetic assessment and display at least one feature of the MetS. All participants will receive an individualised assessment and advice on diet quality from a dietitian, a wearable activity monitor and standard care. Participants randomised to the intervention group will receive acce...
Obesity Research & Clinical Practice, 2019
Journal of Gastroenterology and Hepatology, 2018
Progress in Transplantation, 2021
Introduction Solid organ transplant recipients experience greater cardiometabolic risk than the g... more Introduction Solid organ transplant recipients experience greater cardiometabolic risk than the general population. Following a Mediterranean dietary pattern has been shown to reduce cardiometabolic risk. This study aimed to assess multidisciplinary clinician perspectives of routine nutrition care for kidney and liver transplant recipients and barriers and enablers to implementation of the Mediterranean dietary pattern. Methods Semi-structured individual interviews were conducted with clinicians in a metropolitan health service at tertiary/quaternary transplant centres involved in longer-term management of kidney and liver transplants recipients. Audio-recorded interviews were transcribed verbatim and analysed using thematic content analysis. Findings Nineteen clinicians (9 medical officers, 5 dietitians, 3 nurses and 2 other allied health professionals) were interviewed. Four themes with 11 subthemes were identified: the Mediterranean dietary pattern is not part of routine care (th...
Journal of Telemedicine and Telecare, 2020
Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk fac... more Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25–68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) ‘broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face c...
Annals of Hepatology, 2009
Nutrition & Dietetics, 2019
AimInterventions to prevent excessive weight gain after liver transplant are needed. The purpose ... more AimInterventions to prevent excessive weight gain after liver transplant are needed. The purpose of the present study was to enhance a specialist post‐transplant well‐being program through knowledge exchange with end‐users.MethodsThe study used an interactive process of knowledge exchange between researchers, clinicians and health system users. Data were collected as focus groups or telephone interviews and underwent applied thematic analysis.ResultsThere were 28 participants (age 24–68 years; 64% male). The results identified experiences that may influence decisions around health behaviours during the course of transplant recovery. Three over‐arching themes were identified that impact on liver transplant recipients post‐transplant health behaviours. These include (i) Finding a coping mechanism which highlighted the need to acknowledge the significant emotional burden of transplant prior to addressing long‐term physical wellness; (ii) Back to Life encompassing the desire to return t...
Current Hepatology Reports, 2017
Hepatobiliary surgery and nutrition, 2017
Cardiometabolic risk factors are increasing in liver transplant recipients (LTR). Influencing die... more Cardiometabolic risk factors are increasing in liver transplant recipients (LTR). Influencing dietary factors have not been assessed. The aim of this observational study was to assess changes in weight, metabolic function, dietary intake and eating behaviours in the first year after orthotopic liver transplantation (OLT). Consecutive recruitment of 17 patients (14 males) awaiting OLT at a single tertiary hospital. Dietary intake, food behaviours and anthropometry were recorded at baseline, and 6 and 12 months post-transplant. By 12 months, patients had gained on average 7.3% of body weight. The prevalence of overweight or obesity increased from baseline 53% to 77% (P=0.001). By 6 months, 65% (n=11/17) of patients had altered glucose metabolism. Dietary intake was consistent with a Western-style dietary pattern with high saturated fat. Over half of the patients (69%, n=11/16) reported low to no depressive feelings and rated their self-esteem as good (53%, n=9/16). The Power of Food S...
Liver international : official journal of the International Association for the Study of the Liver, Dec 5, 2017
Research in NAFLD management is commonly based on quantitative assessment of liver fat by proton-... more Research in NAFLD management is commonly based on quantitative assessment of liver fat by proton-magnetic resonance spectroscopy ((1) H-MRS), and translation of this into clinical practice is currently limited by availability and expense. Novel steatosis biomarkers have been proposed for the prediction of liver fatness; however, whether these are suitable for detecting changes in liver fat is unknown. We aimed to determine the accuracy of these indices, and waist circumference (WC), in quantifying longitudinal change in (1) H-MRS-quantified liver fat. We performed a secondary analysis using data from 97 overweight/obese adults (age: 39.7±11.5 years, body mass index: 30.7±4.4 kg/m(2) , liver fat: 6.0±4.8%, 65% male) who completed either an 8-week exercise or 12-week nutraceutical intervention, with varying degrees of change in liver fat. Baseline and post-intervention measures were liver fat ((1) H-MRS), NAFLD Liver Fat Score, Liver Fat Equation (LFE), Fatty Liver Index (FLI), Hepati...
World Journal of Hepatology, 2016
ABSTRACT Hepatitis C virus (HCV) is a major cause of chronic liver disease that may progress to c... more ABSTRACT Hepatitis C virus (HCV) is a major cause of chronic liver disease that may progress to cirrhosis. Antiviral treatment is successful in less than 50% of patients, is costly and causes debilitating side effects. For these reasons, additional therapies to limit the progression of liver disease are urgently required. Steatosis is found in 60% of patients with HCV and is strongly associated with more severe fibrosis. Improvements in biochemical parameters may be seen with weight reduction, however the effects on liver histology have not been investigated. We propose that in patients with chronic HCV and steatosis, obesity contributes to fat in the liver, which results in increased fibrosis and progression to cirrhosis. This study investigated the effect of weight reduction on liver biochemistry and histology in patients with HCV and the success of weight maintenance after an intensive intervention. We examined the effect of a 12 week diet and exercise program where all subjects were seen weekly by the Dietician, with the goal of achieving a 0.5 kg weight loss per week. Biochemistry was monitored monthly and a liver biopsy was performed prior to and 3-6 months after the intervention period. Patients then entered a 12 month weight maintenance program with monthly dietetic review. After 12 weeks there was a mean weight loss of 5.9 ± 3.2 kg and a mean reduction in waist circumference of 9.0 ± 5.0 cm. In 16 of the 19 patients, serum ALT levels fell progressively with weight loss. Mean fasting insulin fell from 16 to 11 mmol/L (p<0.002). Nine of the 10 patients with paired liver biopsies had a reduction in steatosis. The degree of reduction in steatosis was significantly associated with the percentage of weight loss (p=0.005). In these subjects the median fibrosis score decreased from 3 to 1 (p=0.01) To date, 12 patients have completed 6-12 months of the maintenance program with a 55% success rate. Those that have maintained weight have sustained improvements in their liver function. A small amount of weight loss may be associated with a reduction in steatosis and abnormal liver enzymes and an improvement in fibrosis, despite the persistence of the virus.
Applied Physiology, Nutrition, and Metabolism, 2014
Maximal fat oxidation (MFO), as well as the exercise intensity at which it occurs (Fatmax), have ... more Maximal fat oxidation (MFO), as well as the exercise intensity at which it occurs (Fatmax), have been reported as lower in sedentary overweight individuals but have not been studied in trained overweight individuals. The aim of this study was to compare Fatmax and MFO in lean and overweight recreationally trained males matched for cardiorespiratory fitness (CRF) and to study the relationships between these variables, anthropometric characteristics, and CRF. Twelve recreationally trained overweight (high fatness (HiFat) group, 30.0% ± 5.3% body fat) and 12 lean males (low fatness (LoFat), 17.2% ± 5.7% body fat) matched for CRF (maximal oxygen consumption (V̇O2max) 39.0 ± 5.5 vs. 41.4 ± 7.6 mL·kg–1·min–1, p = 0.31) and age (p = 0.93) performed a graded exercise test on a cycle ergometer. V̇O2max and fat and carbohydrate oxidation rates were determined using indirect calorimetry; Fatmax and MFO were determined with a mathematical model (SIN); and % body fat was assessed by air displace...
Liver International, 2012
BackgroundSerum hepcidin concentration is potentially affected by inflammation and iron stores in... more BackgroundSerum hepcidin concentration is potentially affected by inflammation and iron stores in chronic liver disease (CLD), but little is known about the relationship between hepcidin and the degree of hepatic fibrosis. We investigated the potential role of serum hepcidin as a biomarker of advanced liver disease.MethodsSerum hepcidin was measured in 332 adults with CLD of varying aetiologies, 45 healthy and 50 non‐liver disease patient controls. Liver biopsy data were available for 228 CLD subjects.ResultsHepcidin was decreased in CLD patients compared with non‐liver disease patient controls (P < 0.0001) but not healthy controls, and was lowest in those with cirrhosis (P < 0.0001). Serum hepcidin correlated with hepatic hepcidin mRNA expression in 91 biopsy samples available for genetic analysis (r = 0.68, P < 0.0001). Hepcidin also correlated positively with serum ferritin concentration, transferrin saturation, ALT, serum albumin and haemoglobin, but negatively with ser...