Rethinking Liver Disease and Nutrition Screening

As a healthcare provider, I’m always looking for ways to catch problems early and keep people healthy. But sometimes, our current approaches to testing and screening may be missing the mark.

Let’s talk about non-alcoholic fatty liver disease (NAFLD). Did you know that NAFLD affects up to 25% of people worldwide?[1] It’s strongly linked to obesity, diabetes, and a condition called metabolic syndrome. But here’s the thing – we usually don’t scan for NAFLD until liver enzyme tests are abnormal. And those enzymes can be totally normal in up to 80% of people with early-stage NAFLD.[2]

So what can we do? First, we need to get better at identifying who’s at high risk. Obesity and diabetes are big red flags, but even lean people can develop NAFLD.[3] Genetic factors matter too. I think we should be using calculator tools that combine all these risk factors to predict who needs screening, rather than waiting for enzyme elevations.

Nutrition is another area where our testing approaches need a refresh. Right now, we mostly test for deficiencies only in specific high-risk groups. But how do we define “high risk”? Chronic diseases, medications, and even your socioeconomic status can all impact your nutrition. Vitamin D deficiency is super common, but we’re not routinely checking for it.[4]

I believe we need more research on the best ways to screen for nutritional issues and how often to test. We also need to make sure everyone has access to these tests, regardless of income or insurance status.

For my postmenopausal patients with NAFLD, I’m rethinking my hormone therapy prescribing habits too. Some interesting studies suggest that oral estrogen may be harder on the liver than transdermal patches or gels.[5] It’s not definitive, but I think it’s worth discussing the options and leaning towards transdermal for those at high risk.

The bottom line? We can’t afford to be complacent about our current screening and testing practices. We need to constantly question our assumptions, push for more research, and advocate for earlier, more accessible, and more comprehensive testing.

I’m committed to staying on top of the latest evidence and partnering with my patients to catch problems early. Together, we can work towards better liver health and nutrition for all.

What about you? Have you been screened for NAFLD or nutritional deficiencies? What barriers have you encountered? Let’s start a conversation! #FattyLiverAwareness #NutritionMatters #EarlyDetection #PreventionOverTreatment

References:

1. Younossi, Z. M., Koenig, A. B., Abdelatif, D., Fazel, Y., Henry, L., & Wymer, M. (2016). Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology, 64(1), 73-84. https://doi.org/10.1002/hep.28431
2. Mofrad, P., Contos, M. J., Haque, M., Sargeant, C., Fisher, R. A., Luketic, V. A., Sterling, R. K., Shiffman, M. L., Stravitz, R. T., & Sanyal, A. J. (2003). Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology, 37(6), 1286-1292. https://doi.org/10.1053/jhep.2003.50229
3. Younes, R., & Bugianesi, E. (2019). NASH in lean individuals. Seminars in Liver Disease, 39(1), 86-95. https://doi.org/10.1055/s-0038-1677517
4. Sizar, O., Khare, S., Goyal, A., Bansal, P., & Givler, A. (2021). Vitamin D deficiency. In StatPearls. StatPearls Publishing.
5. Kamimura, K., Toba, N., Ichikawa, Y., Nasu, K., Hirata, A., Abe, M., Hagiyama, M., Mizuno, Y., Kawanami, A., Watanabe, S., Shiraishi, A., Harada, T., & Yoshimura, A. (2022). Menopausal hormone therapy exacerbates high-fat diet-induced hepatic steatosis in a mouse model of postmenopausal NASH. Scientific Reports, 12(1), 1618. https://doi.org/10.1038/s41598-022-05617-w