Early Liver Disease Detection Linked to Subsequent Lifestyle Improvements

Patients at risk for non-alcoholic fatty liver disease (NAFLD) or alcohol-related liver disease (ALD) who underwent liver fibrosis screening subsequently improved their lifestyle, especially those who screened positive, a prospective cohort study showed.

Among over 3,000 patients, a positive screening test result for liver fibrosis was associated with alcohol abstinence or decreased use after 6 months (OR 2.07, 95% CI 1.54-2.77, P<0.001), which was slightly attenuated and missed significance at 2 years (OR 1.49, 95% CI 0.96-2.33, P=0.077), reported Maja Thiele, MD, PhD, of Odense University Hospital in Denmark.

Of note, patients who benefitted the most were those with elevated liver stiffness, Thiele noted at the European Association for the Study of the Liver (EASL) annual meeting.

A similar association was seen for diet and exercise, with 26% of patients reporting a reduction in food consumption and/or an increase in the consumption of more healthy food after 1 week, which increased to 34% beyond 6 months. This effect was strongest for the NAFLD-risk group (OR 1.8, 95% CI 1.3-2.4).

“This study is impactful because it shows how with a simple, fast, noninvasive study, we can provide the patient with key information that may lead to significant lifestyle modifications,” said Anthony Martinez, MD, of the University at Buffalo in New York, who was not involved in the study. “The study also shows how we can empower our patients to make needed changes that could alter their disease progression.”

Among the ALD-risk group, 49% reported excess use of alcohol at screening, which dropped to 34% after 6 months. Median alcohol intake reduced to 8 units per week for those who screened negative, and 15 units per week for those who screened positive.

“If we wanted to calculate this as a number needed to treat or a number needed to screen, this is a reduction of 15%, which is a number needed to treat of 7, which for a drug trial would be excellent,” Thiele said.

Only 0.8% of the ALD group increased their alcohol consumption after 1 week.

Among the NAFLD group, a positive screening test predicted a weight loss of over 3 kg (6.6 lb) after 6 months (OR 3.5, 95% CI 1.2-10.5), with 25% achieving this loss.

For this study, Thiele and colleagues examined data on 3,014 patients who underwent screening for liver fibrosis due to risk for NAFLD (n=1,688) or ALD (n=1,326) based on a BMI above 30, the presence of type 2 diabetes or other metabolic syndrome, or excessive drinking for over 5 years.

Patients completed an online questionnaire to evaluate lifestyle changes after undergoing transient elastography (TE); a result was considered positive at TE ≥8 kPa. Thiele and team reported high response rates to the questionnaire — 89% after 1 week, and 85% after 6 months.

Median age of participants was 58, and 54% were men. Only 10% tested positive during screening, and 28% had a high Alcohol Use Disorders Identification Test (AUDIT) score (≥16). Those at risk for ALD were more often men who consumed excessive alcohol. The group at risk for NAFLD was comprised mostly of younger women with a BMI over 31, type 2 diabetes, and metabolic syndrome.

Limitations to the study included recall bias and attrition bias, since some patients did not respond to the questionnaire. Thiele and team also noted that there may be negative consequences from screening with invasive procedures, as well as inducing fear of disease.