fibronostics physician tips liver health

Physician Tip - When Should You Discuss Liver Disease With Patients At Risk?

In a 2014 study in the British Medical Journal[1] British researchers found that a community-based non-invasive liver investigation algorithm could identify a substantial number of patients with previously undetected cirrhosis.

The study involved 504 patients with defined risk factors for chronic liver disease who agreed to undergo investigation, of those, 378 agreed to undergo transient elastography (TE). Testing found 98 (26.8%) with elevated liver stiffness. Of the 98, 71 (72.4%) had elevated stiffness with normal liver enzymes that would have been missed by traditional investigation. In the end they identified 11 new patients with cirrhosis, which was a 140% increase in the number of diagnosed patients in this population.

The study begs the question, when should providers discuss liver disease with patients at risk? With such a substantial increase in identification of actual cases of cirrhosis, it would seem that earlier discussions than previously thought might improve prevention, treatments, and outcomes.

Incidence of non-alcoholic fatty liver disease affects from one-third to 40 percent of your patients with 3 to 12 percent progressing to non-alcoholic steatohepatitis or NASH. While deaths from other common conditions, such as cardiovascular disease, are declining, those due to liver disease have been increasing dramatically.

To make substantial improvements in those numbers a commission of practitioners in the UK published a blueprint for addressing liver disease in 2014 in The Lancet. The commission made 10 key recommendations. The number one priority is to strengthen detection of liver disease at early stages.[2]

More recently a 2018 study in Clinical and Experimental Gastroenterology [iii] found routine liver function lab results correlate poorly with liver disease. The researchers concluded that, “The health care burden from chronic liver disease (CLD) will likely continue to rise, unless clinicians are made aware that normal or near normal laboratory findings may be seen in asymptomatic patients. Earlier identification of asymptomatic patients will allow for treatment with new promising modalities and decrease morbidity and mortality from CLD.”

The dilemma facing providers with patients at-risk of liver disease has until recently been a lack of non-invasive or minimally invasive testing options in between costly imaging studies on the one hand and invasive, risky biopsy on the other hand.

With the development of an array of non-invasive, algorithm-based diagnostic tests, however, clinicians now have low-cost options for accurately identifying and quantifying their patients’ risk well before a patient’s condition demands the expense and added risk of liver biopsy​.

These digital diagnostic tests have been shown to be applicable to 98 percent of patients and accurately produce a liver disease score that quantitatively estimates liver fibrosis and the risk level for advanced liver disease. Importantly, these low-cost repeatable tests make early detection and monitoring more feasible than ever before.

With the increasing numbers of patients at risk due to the escalating epidemic of obesity and diabetes, more and more clinicians are facing the problematic prospect of discussing a patient’s weight in relation to risks for diabetes, heart disease and orthopedic problems. Adding liver disease to the discussion may seem a bit like piling on, but with the prospect of early intervention possibly reversing both diabetes and NAFLD, it is a worthy discussion to have.

In making early detection its highest priority, the UK commission stated that positioning liver disease among the so-called Big Five major chronic, preventable and lifestyle-related diseases of cardiovascular disorders, diabetes, chronic lung disease, and renal disease, would maximize the effect of lifestyle interventions and chronic disease management.

Fibronostics is a healthcare technology company providing algorithm-based solutions in a variety of diagnostic tests to support clinician decision-making. LiverFAStTM is the premier non-invasive liver disease screen for early detection of steatosis, NASH and fibrosis. It is simple, less expensive and offers greater confidence in determining a patient’s level of liver injury and stage of liver disease. Its easy-to-read graphical report makes it ideal for starting the lifestyle conversation with patients.

HealthFACTR is an algorithm-based, broad spectrum health assessment tool targeting & visualizing several of the most critical risks to a person’s health and longevity. It is a scientifically based test addressing key focus areas adversely affecting human health. It has robust clinical support using state-of-the-art gold standard testing methods and backed up by hundreds of clinical support papers. Heart disease, Diabetes, Stroke, Liver disease, Obstructive Sleep Apnea, Cholesterol, Triglyceride, Blood Pressure, HDL, LDL, Diet Assessment, Fitness Assessment, Fitness Goals, Body Fat Analysis - are measured, individual risk assessed, and actions recommended to reduce disease progression. HealthFACTR provides detailed visualization into a person’s metabolic health risks and fitness.

Contact us via email, or by phone at 1-888-552-1603 today to learn more about our LiverFASt™ family of diagnostic tests and HealthFACTR services.


[1] Harman DJ, Ryder SD, James MW, et al. Direct targeting of risk factors significantly increases the detection of liver cirrhosis in primary care: a cross-sectional diagnostic study utilizing transient elastography. BMJ Open 2015;5:e007516. doi:10.1136/bmjopen-2014-007516

[2] Williams R , et al. “Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis.” Lancet 2014;384:1953–97.doi:10.1016/S0140-6736(14)61838-9

[iii] Ahmed, Zohair et al. “Liver function tests in identifying patients with liver disease.” Clinical and experimental gastroenterology vol. 11 301-307. 23 Aug. 2018, doi:10.2147/CEG.S160537


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