An NHS GP has highlighted the early signs of a killer disease - which has risen by a shocking amount in recent years. Dr Mark Porter explained that new data from the British Liver Trust has highlighted a fourfold rise in mortality rates for liver disease over the past 50 years, making it one of the leading causes of death in adults under 65.
The British Liver Trust has said in the UK there are more than 11,000 deaths due to liver disease each year - more than 31 deaths a day. Death rates have quadrupled over the last 50 years and data from England shows that the number of people dying prematurely from liver disease and liver cancer has increased by almost two-thirds (64%) in the last 20 years. 1 in 4 people diagnosed with alcohol-related liver disease in hospital die within 60 days.
The average age of death from liver disease in 2020 in England was 61 for men and 62 for women. Dr Porter said being able to spot the signs early was absolutely crucial: “Put simply, by the time many people develop symptoms of liver damage, the organ is often approaching irreversible end-stage failure.
“There are lots of reasons people develop liver disease, but the main drivers behind the increase over the past 50 years have been viral infection (particularly hepatitis C in the UK), our expanding waistlines, alcohol, and a combination of all three.”
Dr Porter said that he often encounters problems in people drinking 20-30 units a week, and in those consuming 50 or more ‘it’s not so much if they will run into trouble as when’.
Metabolic dysfunction-associated steatotic liver disease:
Dr Porter said there is a key link between diet and lifestyle and non-alcohol related fatty liver disease — metabolic dysfunction-associated steatotic liver disease (MASLD). The British Liver Trust estimates that at least one in five adults in the UK now have some degree of MASLD, most of whom will probably never know and go on to fall ill and die from something different. Dr Porter said: “However, a significant minority will develop worrying liver disease unless mitigating steps are taken.
“Most (but not all) people with MASLD are overweight or obese, with apple-shaped men and women who store fat around their midriff being at particular risk. It is also linked to poor diet, a sedentary lifestyle, high cholesterol levels, raised blood pressure, type 2 diabetes and, in women, polycystic ovarian syndrome.”
Overindulgence:
Dr Porter said that MASLD involves a scarring process that leads to stiffening of the liver and, ‘eventually, cirrhosis and failure’. He explained: “Indeed, similar fatty changes are typically the first sign of trouble in heavy drinkers too, and the pathway to irreversible liver failure much the same from a pathological point of view. You can both drink and eat yourself to a liver disease-related death.”
How is it detected:
Routine blood tests can pick up signs that the liver is struggling - higher than normal levels of liver enzymes in the blood. Dr Porter warned: “But, because of the liver’s initial resilience, getting the all clear from these doesn’t mean yours is healthy. Ultrasound scans are better at detecting early signs of trouble, particularly a FibroScan, which evaluates the stiffness of the organ (a measure of scarring). Both are available on the NHS but generally only where there is a clinical indication, such as deranged blood results.”
He said private screening scans are available to anyone willing to pay — typically £160 to £500 a time depending on the test and the clinic — ‘but in many cases are only likely to confirm what you already suspect: that you are drinking too much, or your diet, lifestyle and/or weight need addressing’.
Treatment:
Dr Porter said: “Treatment for MASLD is all about modifying risk factors. What is good for your heart is good for your liver, so lose excess weight, eat healthily, don’t drink excessively and exercise. And, if you have underlying health issues such as type 2 diabetes, high blood pressure or very high cholesterol levels, ensure these are well controlled.
“And if a liver function test does come back as slightly abnormal, don’t dismiss it (something we doctors are just as guilty of doing as our patients). At the very least regard it as a warning shot, and a prompt to take a closer look at your diet, lifestyle and weight. It won’t just be your liver that thanks you.”
Are you at risk? Take this test
Totting up weekly units of alcohol is only half the story if you are worried about your drinking — or someone else’s. Just as important is how drinking affects your social life, work, relationships and health.
You don’t need to drink heavily every day to have alcohol use disorder (AUD). The Audit questionnaire is a screening tool developed by the World Health Organisation. It’s not foolproof, but should identify nine out of ten people at risk from their drinking.
You can screen yourself at auditscreen.org/check-your-drinking
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