By Jon Gingrich, CEO, Echosens North America
Non-alcoholic fatty liver disease (NAFLD), an asymptomatic disease which is related to a build-up of extra fat in liver cells caused by lifestyle and dietary choices not related to alcohol, is one of the most frequent causes of chronic liver disease and represents the leading indications for liver transplant. It is estimated that 10% of the U.S. population (30 million people) have liver disease and the number is rising in parallel as obesity rates in the US continue to rise.
Additionally, 17.3 million Americans have nonalcoholic steatohepatitis (NASH), the more severe form of NAFLD marked by inflammation and hepatocellular damage (“ballooning”), which can lead to hepatic fibrosis, cirrhosis and hepatocellular cancer (HCC) if left untreated. These conditions contribute billions of dollars to the country’s healthcare costs.
For many years, liver transplant was the go-to last-ditch treatment option for critically ill patients. But transplant is an incredibly expensive treatment option – an estimated $575,000 for the procedure six months pre-op to six months post-op. Furthermore, there are not enough donated organs to begin to meet the need among chronic liver disease patients.
Evolving Liver Disease Management and Treatment
The good news is that the liver can heal with lifestyle changes. Peer-reviewed journal articles from several countries have all arrived at this conclusion, as researchers noted in a recently published article:
Lifestyle modifications are effective in the treatment of NAFLD. Diet, exercise, or the combination of both are beneficial in the treatment of NAFLD. Dietary and exercise changes combined are superior to these interventions alone improving metabolic parameters and liver function tests.
While liver disease is serious, ranking 11th (cirrhosis) and 16th (cancer) worldwide as leading causes of death, non-invasive technology quickly provides at the point of care, a quantitative assessment of liver stiffness and controlled attenuation parameter (CAP), which correlate with liver fibrosis and fat, respectively. Early diagnosis and noninvasive management are clearly the best options for helping patients – providing an early warning opportunity to make important lifestyle changes that can halt or reverse liver damage.
The Rise of Technology Saves Lives and Reduces Costs
NAFLD is a growing public health problem and coupled with obesity -- another well-documented public health crisis and a major driver of NAFLD -- represent “twin epidemics.”
There is a high prevalence of NAFLD among Type-2 diabetic patients and strong association between Type-2 diabetics with NAFLD and risk factors like; obesity, high HbA1c, hyperlipidemia and high ALT, an enzyme. Therefore, early recognition in high-risk patients and intervention like lifestyle modification, maintenance of healthy weight, obesity prevention, treatment of dyslipidemia and good glycemic control should be achieved to prevent NAFLD.
With training, non-invasive quantification of liver fat can easily be performed and monitored by a clinician in a primary care setting. In fact, “American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings” states that transient elastography (TE) is preferred to quantify liver fat (CAP) and fibrosis vibration-controlled transient elastography (VCTE) for risk stratification. These guidelines make it very clear that to stage the risk of fibrosis in people with nonalcoholic fatty liver disease (NAFLD), clinicians should choose VCTE – exemplified by FibroScan – as the best validated to identify advanced disease and predict liver-related outcomes. This technology offers the ideal way to identify patients at risk early to prevent the development of cirrhosis and comorbidities based on screenings with an individual’s liver fibrosis risk (FIB-4).
Empowered with the results, primary care physicians are well-positioned to initiate meaningful conversations with patients around the sensitive topics of obesity and weight loss.
Early Liver Screening is the “Canary in the Coal Mine”
The liver is the Swiss Army knife of organs. Among its contributions to good health, the liver keeps our blood healthy in several ways, including clotting, producing bile to carry away waste, breaking down fat in the gut and clearing toxins from our body.
One ongoing study of 10,000 patients using noninvasive screening technology without a history of liver disease revealed that only 44 percent had normal liver presentation. The majority had some form of liver abnormality; 13% had suspected undiagnosed liver fibrosis or cirrhosis. Consider that a recent study pegged the economic burden of NAFLD at $32 billion annually in the U.S., the enormous cost savings of non-invasive liver screening technology is well apparent. These are healthcare dollars that can be redirected to other needs and help to meet the expectations of emerging value-based economic models that promote wellness and prevention.
Liver disease is an extreme threat to the quality of life - to life itself. It is expensive to treat if left undetected, diverting enormous sums of healthcare dollars that would be better spent on wellness and prevention. In this fight to stem the rising incidence of NAFLD, employers can also do their part by raising awareness among their workforces and what can be done to prevent the onset or progression of NAFLD. This understanding should become a part of employer sponsored wellness initiatives, both for the sake of employees and controlling the company’s healthcare spending.
Echosens, the developer of FibroScan®, is an innovative high-technology company offering a full range of products and services supporting physicians in their assessment and management of patients with chronic liver diseases. FibroScan is supported by over 3,500 peer reviewed publications and 160 international guidelines and examinations are covered by Medicare, Medicaid and many insurance plans. For more information, please visit https://www.echosens.com/.