The American Liver Foundation estimates that more than 30% of the U.S. population has some degree of NAFLD (non-alcoholic fatty liver disease), the most common type of liver disease in the Western world. This can impact other factors of overall health, given the link between NAFLD and diabetes, obesity, insulin resistance, and other metabolic risk factors.
With innovative non-invasive technologies, however, NAFLD is reversible if caught in the early stages and accompanied by lifestyle changes. What’s more, simple screening and early detection can help to prevent more serious conditions, such as end-stage liver disease or liver cancer.
The Role of Early Detection
Physicians can perform a blood test to look for liver enzymes released after a liver cell is injured or dies, which may suggest inflammation. But today’s preferred method is a liver sample through biopsy, which enables doctors to see signs of scar tissue and liver cell damage under a microscope to determine the disease’s progress.
While this method is considered a best practice for diagnosing the progressive forms of NAFLD, NASH (non-alcoholic steatohepatitis), biopsy is an invasive procedure. It also carries potential side effects that are infrequent, but clinically important, and is not considered fully accurate.
Patients who would benefit most from early evaluation include those with components of the metabolic syndrome. The 2019 Standards of Medical Care in Diabetes issued by the ADA recommend that patients with type 2 diabetes or pre-diabetes and elevated liver enzymes or fatty liver should be evaluated for the presence of NASH and liver fibrosis.
Given this expanding need for liver assessment, biopsies with their significant resource and cost burden may be inadequate for patient assessment on a large scale. This makes the adoption of accurate non-invasive measures of liver health of vital importance.
The Value of Non-Invasive Screening Methods
A growing number of healthcare providers have begun to adopt non-invasive screening methods that can detect NAFLD in the absence of indications or warning signs. This innovative and painless approach can be performed in the doctor’s office as part of an annual exam, and is covered by Medicare, Medicaid, and other insurance plans.
A 10-minute screening offers quick insight into liver health—measuring liver fat content and liver stiffness (associated with fibrosis and cirrhosis)—while potentially eliminating the need for a liver biopsy and/or further testing. Test scores provide information the physician can use to make a referral to a specialist or recommend additional assessments. In fact, a yearly NAFLD screening is likely to become standard practice similar to a mammography or A1C blood sugar testing.
FibroScan, for example, is a unique technology that can be used to measure the amount of liver stiffness and fat and to rule out the need for a liver biopsy—saving time and resources for people who don’t need to undergo additional assessment. These quantitative measurements with FibroScan can be used to track changes in liver health over time and can be combined with blood biomarkers to cost-effectively create more sensitive and specific scores for monitoring. Additionally, FibroScan is a portable device that can be operated by a medical assistant and interpreted by the healthcare professional at the point of care delivery, making it a valuable accompaniment for managing patients, irrespective of where they receive care.
Identifying At-Risk Patients
An interim look at an ongoing study of 10,000 patients with no history of liver disease was conducted in community-based endoscopy centers by the FRI (Florida Research Institute). Only 43% of patients evaluated had what is considered normal livers based on a FibroScan assessment alone, while the remainder had some form of liver abnormality, ranging from elevated liver fat to liver fibrosis, including 13% suspected of having undiagnosed liver fibrosis or cirrhosis. While further workup is recommended to confirm the extent of liver disease in these patients, this analysis of the first 367 patients suggests a significant rate of undiagnosed NAFLD in the population studied.
These results highlight the importance of identifying asymptomatic patients who may be at risk for advancing disease for earlier intervention, while the increasing prevalence of disease shows the importance of regular assessment.