Liver disease has become a growing epidemic around the world, raising alarms among providers. According to one study, the annual direct medical costs associated with non-alcoholic fatty liver disease (NAFLD) were estimated to be $103 billion in the United States and €89 billion in Europe.
Liver disease accounts for approximately 2 million deaths per year worldwide, 1 million from complications due to cirrhosis and 1 million from viral hepatitis and hepatocellular carcinoma (HCC). Cirrhosis and liver cancer combined account for 3.5% of all deaths worldwide.
Tied to this epidemic, approximately 2 billion adults are overweight or obese, with a body mass index (BMI) greater than or equal to 30, and over 400 million have diabetes—both of which are risk factors for NAFLD and hepatocellular carcinoma (HCC).
From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to the more severe form of NAFLD called non-alcoholic steatohepatitis (NASH), and more than tripled for decompensated cirrhosis due to NASH. NASH is a challenging, high-volume, and chronic condition that lacks a standardized approach to care and has imposed a substantial health burden on many countries.
While liver disease statistics are staggering, they underscore an important opportunity to raise public awareness about the liver disease epidemic so that more people understand that most liver disease is preventable and, in many cases, reversible with the right lifestyle changes.
A growing number of healthcare providers recognize the positive impact of chronic care disease management (CCDM) programs that integrate non-invasive tests (NITs) in the diagnosis and for optimizing ongoing management of patients with chronic liver disease in a way that can effectively halt its progression.
Critical Risk Factors
Obesity
Obesity is not simply a matter of over-eating, but rather a complex disease that involves an excessive amount of body fat. It’s important to think of this disease as a complex medical issue that increases the risk of heart disease, diabetes, high blood pressure and certain cancers.
Obesity can be devastating on vital organs, especially on the liver, causing insulin resistance that leads to buildup of blood sugar and increases the amount of free fatty acids circulating in the blood and inside the liver cells.
Obesity increases the risk of NAFLD. The Unites States has the most obese adults (109,342,839), followed by China (97,256,700), while Indonesia has the fewest obese adults.
Most of the world’s population live in countries where more people die from being overweight or obese than being underweight. If these trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022.
Type 2 Diabetes
Type 2 diabetes is also an important risk factor for NAFLD and NASH. While Type 2 diabetes is tied to obesity, its relevance in NAFLD is two-fold. First, the presence of NAFLD increases the incidence of Type 2 diabetes and, second, diabetes aggravates NAFLD to more severe forms of steatohepatitis, cirrhosis, and HCC. In fact, the prevalence of NAFLD and NASH in patients with Type 2 diabetes is more than 60%.
Approximately 463 million adults worldwide live with diabetes and by 2045 that number will rise to 700 million. Fat in the liver can increase the risks of progression of prediabetes to overt disease. Once a patient has fatty liver disease, diabetes may become more difficult to control, making it critical to obtain an early diagnosis and introduce lifestyle changes to halt or reverse NAFLD.
Holistic Approach Combined with NITs
Because NAFLD and NASH are so tightly intertwined with obesity, diabetes and lifestyle, a holistic approach to patient engagement can help support behavioral changes that will lead to better outcomes across the co-morbid conditions affecting the individual patient. Recent studies show that noninvasive exams at the point of care can cost-effectively identify individuals at risk for liver disease.
Chronic Care Disease Management
A CCDM program should be designed to target liver health to not only address the broader needs of individuals, but also prevent NASH. In recent years, the fibrosis stage of liver disease has been identified as the most important predictor of liver outcomes, making it critical to identify patients with NAFLD and NASH.
A follow-up visit ensures that the patient is following the weight loss program, consulting with a dietician or nutritionist and adhering to the CCDM program. It’s also helpful to share the patient’s liver exam score with them to illustrate the change in liver fat and potential need for adjusting treatment. This is where noninvasive tests play a key role.
The Value of Noninvasive Liver Exams
A growing number of primary care physicians and specialists are seeking cost-effective ways to detect and monitor liver disease, being mindful that current approaches for identifying fibrotic NASH tend to be complicated, expensive, and potentially wasteful.
A recent expert review suggests a streamlined approach that is cost-effective. Researchers identified vibration controlled transient elastography (VCTE) as a useful direct biomarker of liver stiffness and fat in point of care. A CCDM program helps educate plan members about maintaining liver health, mitigates the high costs of prescriptions and aids preventive measures.
Furthermore, a VCTE tool delivers value by quickly providing a quantitative assessment of liver stiffness and liver fat at the point of care, making the detection of liver disease and long-term care for individuals with NAFLD and NASH more effective.
These non-invasive tools provide a simple, validated, and reliable exam in less than 10 minutes. It does this by early identification of patients with liver disease for proactive intervention and behavior change to slow disease progression. For those identified with liver fibrosis, this exam can also reduce the aggregate volume of some current diagnosis methods, such as liver biopsy.
The most effective non-invasive VCTE exams are highly mobile, can be operated by a medical assistant and interpreted by the healthcare professional. They produce numeric measurements, rather than images, for simplified interpretation and consistency of measurement. This allows clinicians to monitor changes in liver tissue over time.
What’s more, VCTE tools combine standardization, clinical performance, and accessibility for early patient identification either in a diabetology clinic, liver clinic or primary care setting. They are used for advanced liver disease patient management and portal hypertension risk stratification.
The high prevalence rate of liver disease in overweight and obese adults calls for attention and dedicated action from liver specialists, health policy makers, the general public and primary care physicians alike to help reverse these twin epidemics and reduce costs associated with liver disease and obesity. Fortunately, the technology exists to help reverse this global trend.