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Liver disease targeted by Lancet Commission

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Leading medical experts are warning that rising numbers of deaths from liver disease – already the UK’s third commonest cause of premature death – will be unavoidable without radical improvements in treatment and detection services, and tougher government policies to control the excessive alcohol use and obesity responsible for much of the national burden of liver disease.

In a new Lancet Commission, led by Professor Roger Williams, Director of the Institute of Hepatology, London, UK, doctors and medical scientists from across the UK are calling for a radical scale up of liver disease treatment and detection facilities in the country, which has one of the worst rates of death from liver disease in Europe.

The UK is the only country in western Europe, except Finland, where the prevalence of liver disease has increased in the past three decades, and the rate of death from the disease for those under the age of 65 years has increased by almost 500% since 1970.

As a result of increasing rates of obesity, 25% of the population are estimated to have non-alcoholic fatty liver disease; about 10% of these people have been diagnosed in community studies to have evidence of advanced liver fibrosis. Progression to end-stage liver disease and primary hepatocellular carcinoma is increasingly reported.Development ofType 2 diabetes, which is increasing in frequency in parallel with obesity, carries an additional risk factor for liver disease, namely non-alcoholic fatty liver disease. According to Duncan Selbie, Head of Public Health England, the obesity crisis could result in the number of people with type 2 diabetes trebling during the next 20 years to 6.2 million by 2034.

Reducing your riskReducing your risk

Simon O’Neill, Director of Health Intelligence at Diabetes UK, said: “Non-alcoholic fatty liver disease is more commonly associated with people with Type 2 diabetes because of its link to obesity. Maintaining a healthy weight, stopping smoking if you currently smoke and having good control of blood glucose and blood cholesterol can all help people with diabetes reduce their risk of developing non-alcoholic fatty liver disease.  People with diabetes should discuss their risk of developing non-alcoholic fatty liver disease with their GP and ask for a liver function test if they are concerned.

“We are already recommending that the Government urgently consider legislation to introduce marketing restrictions on unhealthy foods and more robust regulation of the food and drinks industry. We need to make it as easy as possible for people to lead fit, healthy and active lives and, if necessary, encouraging healthy lifestyles through taxation should also be considered.”

Professor Willams said: “There is a human, social, and financial imperative to act now if the UK’s burden of liver disease and all its consequences are to be tackled and the NHS is not to be overwhelmed by the cost of treating advanced stage liver disease.”

Although 1 in 10 people in the UK will experience liver disease at some stage in their lifetime, the Commission shows that nationally, early detection of liver disease through primary care services (such as GPs and walk-in centres) is virtually non-existent, despite the fact that the disease is much more effectively treated when identified early.

The burden of liver disease in different regions of the UK is closely linked to socioeconomic deprivation, with areas such as the north west of England experiencing nearly four times as many deaths from liver disease as more affluent areas.

Despite the fact that these regions experience a far greater burden of death and illness from liver disease, the Commission shows that specialist treatment services for liver disease in its advanced stages are unevenly distributed throughout the UK, with some of the regions most badly affected having inadequate specialist provision, leading to a postcode lottery for patients which is resulting in unacceptable rates of death and illness in many regions of the UK.

Committment needed to address lifestyle factorsCommittment needed to address lifestyle factors

As well as improving treatment and detection services, the Commission argues that a powerful commitment is needed from UK policymakers to implement policies which address the lifestyle factors leading to most death and illness from liver disease, especially excessive alcohol use and obesity.  This includes recommendations to implement minimum pricing policies for alcohol, prominent health warnings on alcohol packaging, and regulation of sugar content in food and soft drinks.

The Commission recommends:

•    Liver Units providing acute services are established in every District General Hospital in the UK, linked with 30 Specialist Centres – for more complicated cases - distributed equitably around the country.•    Screening of high risk individuals using new diagnostic techniques are part of proposed improvements at GP and community level.•    A review of the transplant services to ensure better access for patients in some areas of the country, and to ensure sufficient capacity for an anticipated 50% increase in availability of donor organs by 2020.

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