Rush to treat liver patients causing more harm than good

December 11, 2017 by David Lewis, University of Leeds
Rush to treat liver patients causing more harm than good
Credit: University of Leeds

Doctors risk overdiagnosing the most common and fastest-growing liver condition, exposing patients to harmful tests, according to a study published today.

It is estimated that one in four in the world is suffering from non-alcoholic (NAFLD), and there are concerns it could lead to cirrhosis.

Expert bodies in Europe are now calling for patients to be screened for the condition and the National Institute for Health and Care Excellence (NICE) in the UK has issued guidance to doctors indicating that at-risk groups should be tested.

But Dr Ian Rowe, specialist and academic fellow at the University of Leeds, in an article in The Lancet Gastroenterology and Hepatology, argued that the rush to identify the disease is not supported by the findings of published medical research.

He said the benefits of were unknown – and no licensed drug treatments were available to people who have NAFLD.

Dr Rowe said: "The case for screening is unproven – and the overwhelming published evidence suggests that the vast majority of people who have NAFLD live with the condition without it impacting on their health.

"For doctors to push for screening in those circumstances will lead to overdiagnosis, and it's known that overdiagnosis can be harmful because it exposes people to unnecessary investigations and treatments – they become labelled with a condition, and it adds to the costs of healthcare."

A new condition

The liver is the second largest organ in the body and, among other complex functions, it plays a central role in fighting infections and illness.

A healthy liver should contain little or no fat. It has been known for a long time that drinking too much alcohol causes fat to develop in the liver.

But in the mid-1980s, doctors began to find that in some people, fat build-up was happening in the absence of alcohol. The condition non-alcoholic fatty liver disease (NAFLD) was coined and is more likely in people who are overweight, obese, have type 2 diabetes or .

It can lead to inflammation and scarring of the liver and cirrhosis, a serious and life-threatening condition. But those take years to develop and only occur in a small minority of people with NAFLD.

Uncertain science

In his review of the published scientific evidence, Dr Rowe said there had been a small number of studies that suggested NAFLD was an aggressive condition that increases the risk of progressive liver disease.

But he added that those studies were open to critique because of the small number of patients tracked and possible bias in the way they were selected for investigation, factors which have overstated the threat the disease poses and created a "...heightened anxiety around the need to diagnose NAFLD".

For patients with NAFLD, the main causes of death are heart disease and cancer.

Evidence of over diagnosis

Dr Rowe said data for England shows that in 2016, 66,276 people were admitted to hospital with NAFLD listed as one of the reasons why – a 27-fold increase on the figure for 2001.

But for the same period, the number of deaths where NAFLD was listed as the primary cause went from 165 to 412 – only a threefold increase.

Dr Rowe said that since only a of patients with NAFLD will suffer complications linked to the condition, this made real the risk that people were undergoing unnecessary invasive investigations – including liver biopsy, where a small sample of the liver is removed.

He said for screening to be introduced, research was needed to identify the benefits and harms of early diagnosis, to understand the impact that diagnosis might have on and the public.

Explore further: Family of patients with NAFLD and cirrhosis are at increased risk of liver fibrosis

Related Stories

Family of patients with NAFLD and cirrhosis are at increased risk of liver fibrosis

June 19, 2017
Non-alcoholic fatty liver disease (NAFLD) is a common disorder characterized by abnormal accumulation of fat in the liver. NAFLD is diagnosed in up to one in three adults and one in 10 children in the United States, and obesity ...

Waist not weight—the key to non-alcoholic fatty liver disease

April 16, 2016
A new study presented today demonstrates that a build-up of fat around the waist can cause more serious complications than obesity in the development of non-alcoholic fatty liver disease (NAFLD). The study was presented at ...

Guidelines updated for diagnosis, management of NAFLD

July 19, 2017
(HealthDay)—A practice guidance statement, published online July 17 in Hepatology, has been developed to augment the clinical practice guidelines for the diagnosis and management of non-alcoholic fatty liver disease (NAFLD).

Nonalcoholic fatty liver disease increases risk of liver, colorectal, and breast cancers

November 13, 2017
Nonalcoholic fatty liver disease (NAFLD) is one of the more common chronic liver diseases worldwide. It is associated with metabolic syndrome (i.e. insulin resistance and diabetes) and predisposes to cardiovascular disease. ...

NASH associated with a 50 percent higher chance of death compared with NAFLD

April 24, 2015
Results from a large population-based cohort of almost a million people in the UK found that the chances of dying from non-alcoholic steatohepatitis (NASH), over a 14-year period, was approximately 50% higher than for those ...

Many diabetics don't know they have serious liver disease

September 21, 2015
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the Western world. NAFLD is a frequent finding in patients with type 2 diabetes, but the exact prevalence of NAFLD, as well as whether patients ...

Recommended for you

Past encounters with the flu shape vaccine response

February 20, 2018
New research on why the influenza vaccine was only modestly effective in recent years shows that immune history with the flu influences a person's response to the vaccine.

Building better tiny kidneys to test drugs and help people avoid dialysis

February 16, 2018
A free online kidney atlas built by USC researchers empowers stem cell scientists everywhere to generate more human-like tiny kidneys for testing new drugs and creating renal replacement therapies.

Expanding Hepatitis C testing to all adults is cost-effective and improves outcomes

February 16, 2018
According to a new study, screening all adults for hepatitis C (HCV) is a cost-effective way to improve clinical outcomes of HCV and identify more infected people compared to current recommendations. Using a simulation model, ...

Study suggests expanded range for emerging tick-borne disease

February 16, 2018
Human cases of Borrelia miyamotoi, a tick-borne infection with some similarities to Lyme disease, were discovered in the eastern United States less than a decade ago. Now new research led by the Yale School of Public Health ...

IFN-mediated immunity to influenza A virus infection influenced by RIPK3 protein

February 15, 2018
Each year, influenza kills half a million people globally with the elderly and very young most often the victims. In fact, the Centers for Disease Control and Prevention reported 37 children have died in the United States ...

Flu shot only 36 percent effective, making bad year worse (Update)

February 15, 2018
The flu vaccine is doing a poor job protecting older Americans and others against the bug that's causing most illnesses.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.