Prevalence and severity of non‐alcoholic fatty liver disease are underestimated in clinical practice: impact of a dedicated screening approach at a large university teaching hospital

Abstract

Aims To define the attitudes and current clinical practice of diabetes specialists with regard to non-alcoholic fatty liver disease and, based on the results, implement an evidenced-based pathway for non-alcoholic fatty liver disease assessment.Methods An online survey was disseminated to diabetes specialists. Based on findings from this survey, we sought a local solution by launching an awareness campaign and implementing a screening algorithm across all diabetes clinics at a secondary/tertiary referral centre.Results A total of 133 diabetes specialists responded to the survey. Fewer than 5% of responders correctly assessed the prevalence and severity of advanced fibrotic non-alcoholic fatty liver disease in people with diabetes as 50-75%. Whilst most clinicians performed liver function tests, only 5.7% responded stating that they would use, or had used, a noninvasive algorithm to stage the severity of non-alcoholic fatty liver disease. Implementing a local non-alcoholic fatty liver disease awareness campaign and screening strategy using pre-printed blood request forms, we ensured that 100% (n=395) of all people with Type 1 and Type 2 diabetes mellitus attending secondary/tertiary care diabetes clinics over a 6-month period were appropriately screened for advanced fibrotic non-alcoholic fatty liver disease using the Fib-4 index; 17.9% required further investigation or assessment.Conclusions The prevalence and severity of non-alcoholic fatty liver disease are underestimated among diabetes specialists. The Fib-4 index can easily be incorporated into clinical practice in secondary/tertiary care to identify those individuals at risk of advanced fibrosis who require further assessment and who may benefit from a dedicated multidisciplinary approach to their management. Diabet. Med. 35, 89-98 (2018)

Factors associated with advanced hepatic fibrosis in patients with various internal diseases: A multicenter community‐based survey

“…In this study, the prevalence of high Fib‐4 index was 29.7% in patients with endocrinology diseases, of which DM accounted for 77%. Previous studies have demonstrated that a high Fib‐4 index is observed in 17.9% to 30.0% of patients with DM or obesity . Thus, our data was in agreement with previous reports.…”

Nonalcoholic Fatty Liver Disease and Renal Function Impairment: A Cross‐Sectional Population‐Based Study on Its Relationship From 1999 to 2016

“…As noted in this study, the health literacy of patients with NAFLD and NAFLD‐RI was very low, with only 5%‐10% aware of their disease, although an encouraging finding was that the chance of patients becoming aware they had a liver and or kidney disease increased as their encounters with the health care system increased. As practitioners, one must be aware that part of the health literacy complex is dependent on the health care provider’s knowledge and awareness of disease, which for NAFLD has been found to be low among general practitioners and other specialists . Therefore, focused efforts need to be directed toward the development of a provider education program, realizing that this recommendation is not without its challenges due to the complexity of diagnosing and treating NAFLD .…”

What's in a name? Renaming ‘NAFLD’ to ‘MAFLD’

“…Many patients link liver disease solely to excess drinking and this can be a substantial barrier to acceptance of their diagnosis and to reluctance in moving through the stages of behavioural change and life‐style interventions. This barrier is compounded if alcohol consumption is within the current recommended limits for the current definition of NAFLD 39,40 . Thus, renaming is the first pivotal step in the patient management journey to increase their understanding of, and perceptions of their disease, which then translates to better acceptance of therapeutic strategies.…”