Physicians as healers: detecting liver fibrosis early may promote lifestyle changes

Health and Wellness 29. feb 2024 2 min Professor og Department Chair Aleksander Krag Written by Morten Busch

Although alcohol-related damage and overweight are known risk factors for health problems, motivating people to change their lifestyle is difficult. However, a new study shows that screening for liver fibrosis may change this. Discussing specific liver damage with a a physician motivates people to drink less alcohol, improve their diet and exercise. This emphasises the importance of specific and relevant knowledge and the value of personal discussion in preventing disease and promoting health.

Although many people know that drinking alcohol is unhealthy and that being overweight can lead to many unhealthy conditions, most studies show that motivating people to change lifestyle through information campaigns is very difficult. Nevertheless, a new major study linked screening for liver fibrosis and positive lifestyle changes. However, the key to these changes was completely different.

“General knowledge is not very effective at motivating people to change lifestyle. But specific knowledge is different. In our study, people with a higher risk of liver damage were screened and discussed the results with a physician who could explain that they had liver damage. The good thing is that the liver damage is reversible. They can do something. That discussion made these people drink less alcohol, and improve their diet, exercise habits and weight. So the physician took on the role of healer,” explains Aleksander Krag, Professor og Department Chair, Department of Gastroenterology and Hepatology, Odense University Hospital, Denmark.

Nearly 5,000 higher-risk individuals

Globally, more than 100 million people consume excessive alcohol and the prevalence of steatotic liver disease is increasing. Early detection of liver fibrosis has therefore become more important than ever.

“People with liver disease generally present to healthcare very late, and then healing is difficult. So early detection is important. Many liver diseases are driven by alcohol or type 2 diabetes and obesity, so changing lifestyle is crucial,” says Aleksander Krag.

The study included 4,756 individuals with a higher risk of alcohol-associated or metabolic dysfunction–associated steatotic liver disease. The aim was to assess the short- and long-term effects associated with screening for liver fibrosis, including whether these people improved their lifestyle.

“We screened the participants for liver fibrosis using transient elastography, assessing the stiffness of the liver, which indicates fibrosis. Then we counselled all participants, regardless of the result of the screening, on changing their lifestyle in relation to alcohol intake, diet, exercise and weight,” adds Aleksander Krag.

Providing a broader perspective

The effects of the counselling were evaluated using questionnaires after one week and six months and after two years for a subgroup.

According to Aleksander Krag screening for liver fibrosis was associated with sustained improvements in lifestyle. “They reduced alcohol consumption, ate better, lost weight and exercised much more. Participants who tested positive in the screening had the most pronounced changes, but all participants improved.”

The new study is unique – not just because of the number of participants. Previous studies often focused on smaller, more specialised groups or had high dropout, but these researcher-physicians achieved a response rate of 84%.

“We examined many people at higher risk of liver disease, which provides a broader perspective on how screening can promote lifestyle changes among different groups,” explains Aleksander Krag.

The new findings indicate that screening can not only detect advanced fibrosis early but also increase motivation for changing lifestyle. The study therefore shows how to prevent disease and promote health, detect disease early and comprise part of the treatment for liver diseases.

Excellent societal investment

Previous screening studies of diabetes were associated with only minor and inconsistent lifestyle changes, and only large studies screening for cardiovascular diseases with extensive lifestyle counselling have led to improved diet and exercise habits at five-year follow-up.

“Our study highlights the importance of specific knowledge – in this case targeted screening and a relevant discussion with a physician. So we can still achieve significant health benefits with minimal intervention. The discussion with the physician, who provides information on the relevant risks in the situation, seems to be enough,” says Aleksander Krag.

The researchers observed short-term improvements in lifestyle and also after two years, suggesting that screening can have a lasting positive impact. Although further research is needed to establish the causal relationships, Aleksander Krag is certain about the potential of preventing disease and promoting health in the future.

“Our results emphasise the potential of screening for liver fibrosis as an integral part of disease prevention, health promotion, early detection and treatment of alcohol-related liver diseases. Brief screening and a discussion with a physician at least every two years would be an excellent societal investment to slow down the increase in the number of people with these diseases,” concludes Aleksander Krag.

Aleksander Krag, MD, PhD, MBA is Professor and Department Chair, Department of Gastroenterology and Hepatology Odense University Hospital, Director of...

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