UK Commission: Liver Disease on the Rise

Beth Skwarecki

November 27, 2014

Mortality rates from liver diseases have skyrocketed since 1970 in the United Kingdom, according to a new report, whereas other broad categories of disease, including stroke, diabetes, and heart disease, have decreased.

"Liver disease constitutes the third commonest cause of premature death in the UK and the rate of increase of liver disease is substantially higher in the UK than other countries in western Europe," write Roger Williams, MD, from the Foundation for Liver Research, and colleagues.

The new report was published online November 27, 2014 in the Lancet.

In addition to measures to reduce alcohol consumption, the key recommendations include:

  • Reduce nonalcoholic fatty liver disease (NAFLD) by reducing obesity. An estimated third of obese individuals have NAFLD, and 8% of these are at risk for substantial liver fibrosis and may experience cirrhosis and cancer as an eventual result. The authors call for better study of how NAFLD progresses to nonalcoholic steatohepatitis. They also recommend government regulations to reduce sugar consumption, such as a soda tax and restrictions on advertising, and emphasize the need for better detection of NAFLD, which often goes undiagnosed.

  • Eradicate chronic hepatitis C by 2030 and reduce the burden of hepatitis B. Both diseases could optimistically be eradicated within 20 to 30 years, Dr Williams and colleagues write, mainly as a result of improved antiviral treatments. They write that "[a]ssociated financial costs will be high in the short term, but ultimately will be cost effective and easy to justify to medium-term health-care strategists."

  • Because children with liver disease are more often surviving to adulthood now, the report recommends better transitional care for these children as they become adults. The National Institute for Health and Care Excellence is developing guidelines aiming to teach adolescents how to care for themselves within the adult care system.

  • Reorganize liver disease care into a two-tier system, with liver units available for acute care at general hospitals and with 30 regional specialist centers distributed regionally. Arrangements should be available to easily transfer patients from one tier to the other, Dr Williams and colleagues write, and the acute care hospitals should include a multidisciplinary alcohol care team.

  • The commission also recommends better early detection of liver problems. Although liver disease often progresses over the course of decades, with many opportunities for intervention, about three quarters of patients with cirrhosis are undiagnosed until they are hospitalized for end-stage liver disease. Dr Williams and colleagues write that primary care providers should be on the alert for signs of liver disease alongside hypertension and diabetes, with which it shares risk factors.

Because existing liver function tests do not typically include reliable markers of liver damage, the authors write that all liver function tests should be returned with an aspartate aminotransferase to serum alanine aminotransferase ratio. At a cutoff of 0.8, the test has a negative predictive value of 93% for substantial fibrosis and would allow providers to identify patients most at risk for developing progressive liver disease.

The authors have disclosed no relevant financial relationships.

Lancet. Published online November 27, 2014. Abstract


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.