Fibrosis Screening May Spark Lifestyle Changes in Individuals at Risk of Liver Disease

Screening for liver fibrosis may motivate individuals at risk of alcohol-related liver disease (ALD) or metabolic dysfunction-associated steatotic liver disease (MASLD) to make lifestyle changes to improve their alcohol consumption, diet, weight, and exercise.

Findings from a prospective cohort study showed self-reported lifestyle changes were more pronounced among individuals whose transient elastography results indicated elevated liver stiffness, although the perceived benefits of screening were not limited to fibrosis-positive individuals and no group experienced worsened lifestyle habits.¹

“Advice based on biological markers has been effective in other fields such as respiratory medicine. In liver disease, few studies have investigated whether knowledge on liver disease can be used as a tool to initiate lifestyle changes, but they are limited by small sample sizes and high attrition rates,” wrote Maria Kjaergaard, MD, of the department of gastroenterology and hepatology at Odense University Hospital in Denmark, and colleagues.¹

Approximately 4.5 million adults in the US have some form of liver disease. Heavy alcohol use and metabolic conditions are among several known causes of fibrosis, explaining why diet and lifestyle changes are considered viable options for preventing and treating liver disease. Speculation about the impact of knowledge regarding liver disease has suggested it may benefit at-risk patients and promote lifestyle changes, although little research has explored the exact impact of fibrosis screening on these outcomes.²

To examine short- and long-term consequences after screening for liver fibrosis with transient elastography in individuals at risk of ALD or MASLD, investigators examined self-reported changes in alcohol, diet, exercise, and weight in people 30-75 years of age with disease risk factors.¹

Investigators defined being at risk of ALD as having a current or previous alcohol intake > 14 units/week for women and > 21 units/week for men for > 5 years with no metabolic risk factors. Patients were considered at risk of MASLD if they had ≥ 1 of the following: BMI ≥30 kg/m2, type 2 diabetes, or metabolic syndrome, paired with the absence of prolonged alcohol overuse.¹

Participants were recruited from the general population through random personal invitations and community calls. Individuals with known chronic liver disease, cancer, or other diseases with an expected survival of < 1 year were excluded from the study.¹

Upon enrollment, participants were screened for liver fibrosis with transient elastography using FibroScan while in a ≥ 6-hour fasting state. Diet, exercise, current and previous alcohol use, and the Alcohol Use Disorder Identification Test (AUDIT) were assessed through an electronic questionnaire 1 week and 6 months after screening.¹

Between October 2017 and October 2022, 46,227 individuals were invited to participate in the study, 4796 of whom were included: 1850 were determined to be at risk of ALD and 2946 were at risk of MASLD. More than half (52%) of participants were male and the median age was 58 years.¹

Among the cohort, 184 (10%) screening positives were identified in the ALD group and 199 (7%) in the MASLD group, as evidenced by transient elastography ≥8 kPa. The 1-week questionnaire was completed by 87% of participants whereas 84% responded to the 6-month questionnaire.¹

Most ALD participants reported decreased average alcohol consumption immediately after screening and through 6 months of follow-up. Investigators pointed out self-reported excessive drinking in this group decreased from 46% to 32% after 6 months.¹

A positive screening test was associated with abstinence/decreased alcohol use after 6 months (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.26-2.64; P = .001), most pronounced in participants with high-risk drinking at baseline (OR, 2.45; 95% CI, 1.32-4.57; P = .005).¹

Investigators observed sustained reductions in weekly drinks from 6 months to a repeated interview at 2 years post-screening in 557 participants at risk of ALD. Of note, only screening-positive individuals retained lower drinking habits, and a positive screening test predicted abstinence or decreased alcohol use after 2 years (OR, 1.84; 95% CI, 1.09-3.11; P = .023).¹

In the MASLD group, similar improvements were observed – at 1 week, 26% of participants reported decreased calorie intake and/or a healthier diet and 35% reported the same after 6 months (P < .001). Again, this finding was more pronounced among screening-positive participants (45%) than screening-negative participants (32%; P = .007).¹

After 1 week, 12% of the MASLD group reported increased exercise levels, a figure that increased to 22% after 6 months (P <.001). More screening-positive participants increased their exercise after 1 week than screening negatives (P = .045), but there was no difference after 6 months (P = .773).¹

“A screening programme may combine early detection of advanced fibrosis with increased motivation to lifestyle changes, and may consequently act as both prevention, early detection, and part of the treatment,” investigators concluded.¹

References:

1. Kjaergaard M, Lindvig KP, Thorhauge KH, et al. Screening for fibrosis promotes life-style changes. A prospective cohort study in 4,796 individuals. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2023.12.018
2. Cleveland Clinic. Liver Disease. Diseases and Conditions. October 4, 2023. Accessed January 12, 2024. https://my.clevelandclinic.org/health/diseases/17179-liver-disease