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Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations

 

The clinical leadership team at Advanced Plan for Health (APH) is pleased to see that nonalcoholic fatty liver disease (NAFLD) is finally beginning to receive needed attention, because early visibility and intervention can prevent, slow or reverse symptoms reducing liver cancer, liver failure and future liver transplants.

Most people are not aware of fatty liver disease until they are told that they have this potentially deadly, life-sapping condition. Even once diagnosed, people often don’t know how to address the situation and reduce their risk. This is why APH is taking a proactive stance in broadcasting the prevalence and risks of fatty liver disease, which impacts at least a quarter of the U.S. population1, and can be prevented or slowed by addressing sedentary lifestyles and poor eating habits, and encouraging those impacted to work with their healthcare provider and nurse health coach / nurse navigator to manage health risks and chronic disease conditions.

Heightened awareness is needed, because symptoms may not appear until late in the disease. The liver is a vital organ, and liver failure is terminal without a transplant. Fatty liver disease is a major reason that more individuals need liver transplants, resulting in the probability that demand for livers will exceed the supply in a few short years.

The widespread epidemic of non-alcoholic fatty liver disease is the third most common reason for liver transplants in the U.S.2  

According to Raluca Pais et. al. in a scholarly article entitled “NAFLD and liver transplantation: Current burden and expected challenges,” published in the Journal of Hepatology in December, 20163, the authors opined,

“The absolute number of LT performed is roughly 6000 per year in both Europe and the United States. However, the frequency of transplant for NAFLD has  steadily increased and is expected to continue to do so, while that for other  etiologies of chronic liver disease have decreased or remained unchanged in  recent years.” 

What if you could impact liver health and keep some plan members / employees from progressing to more serious, life altering, expensive liver disease; like liver cirrhosis and ultimately liver cancer, failure or a liver transplant?

Early signs of liver disease often include the presence of excessive fat deposits and elevated liver enzymes. When the fatty liver is accompanied by inflammation or is caused by heavy alcohol consumption (alcoholic liver disease), the endpoint can be liver cancer or failure with the need for a liver transplant.

There are two other types of nonalcoholic fatty liver disease. One is simple fatty liver disease (steatosis), where there is minimal inflammation and little to no liver disease. Although simple fatty liver disease does not usually cause damage or complications, some individuals go on to have the more serious form known as nonalcoholic steatohepatitis (NASH), where there is not only excessive fat accumulation in the liver, but also inflammation which results in progressive fibrosis and scarring (cirrhosis), and ultimately to end stage liver disease, or hepatocellular carcinoma.

Everyone has some liver fat, but when the fat exceeds 5 to 10 percent of the liver’s weight, then there is a diagnosable problem. Fortunately, most folks with excessive fat accumulation have the simple fatty liver disease variety. However, about 3 to 12 percent of these Americans have the NASH form4, which is the severe kind that results in complications. Because progressive liver disease is silent, the cirrhosis can be very advanced before the disease is symptomatic and diagnosed.

NAFLD is more prevalent in individuals with type 2 diabetes, those with symptoms of metabolic syndrome and individuals who are obese. Nearly 90 percent of those who undergo bariatric surgery have some form of fatty liver disease5. This is probably a known statistic, because of the rigorous testing process associated with qualifying for the surgery. Others may have fatty liver disease for an extended period, and not even know it.

Who is at Risk?

While some individuals have no common risk factors associated with nonalcoholic fatty liver disease, the following modifiable symptoms or conditions are frequently associated, including:

Diabetes

Excess weight or obesity

High cholesterol or triglycerides

Rapid weight loss 

Poor eating habits

Metabolic Syndrome

Sedentary lifestyle

The Good News Is… 

Simple fatty liver (steatosis) disease can usually be prevented or reversed with lifestyle modification; like healthy nutrition, weight loss, managing health risks / chronic conditions and adequate aerobic exercise  That is why clients whose programs are guided by Advanced Plan for Health’s (APH) Poindexter analytics and clinical leadership support, are adding people with NAFLD to the candidates for wellness promotion and / or disease management, as they would do for those with other chronic conditions like diabetes, hypertension, advanced chronic kidney disease or other ongoing health diagnoses that improve with professional nurse intervention.

If a person has NASH or is a heavy alcohol user, positive lifestyle changes, risk management and minimal use or cessation of alcohol intake can be helpful in reducing symptoms or delaying the onset of advanced liver scarring, inflammation and ultimately cirrhosis or liver cancer. There is no cure for nonalcoholic fatty liver disease, but early intervention may prevent, reverse or slow symptoms. Appropriate intervention and prevention could save debility, death or a liver transplant in the future.

We strongly recommend you put NAFLD on your radar, especially for those with the diagnosis of fatty liver disease in your population.

Advanced Plan For Health (APH) Has the Tools You Need 

APH has our Poindexter advanced and predictive analytics system that enables clients to identify individuals with liver disease. Poindexter’s simple-to-use analytics tools support Nurse Health Coaches / Nurse Navigators in developing collaborative treatment plans with providers and the participant, implementing that plan, and measuring the impact. If the desired progress is not made, it is a quick, simple matter to revisit the action plan and modify it into simple steps that work better for the involved participant to ensure desired outcomes.

Contact us if you’d like to learn more about how our Poindexter analytics can deliver the macro to micro-level visibility you need to identify and support those with Fatty Liver Disease, or other predictors of diseases and co-morbidities in your population.


References

[1] http://www.liverfoundation.org/abouttheliver/info/nafld/

[2] http://www.liverfoundation.org/education/liverlowdown/ll1013/bigpicture/ 

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5326676/   

[4] https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts 

[5] Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–2023.