Screening for liver stiffness at the state fair yields high results, response
Voluntary liver stiffness screening via onsite ultrasound during the Minnesota State Fair yielded high prevalence of liver disease among people previously unaware of any liver disease while 1 month follow-up showed a 70% change of lifestyle in those presenting at high risk, according to data out of Digestive Disease Week.
“Not screening for liver disease is totally wrong,” Piet de Groen, MD, of the University of Minnesota, told Healio Gastroenterology and Liver Disease. “None of the 132 knew they had liver disease. All were new. The liver disease for some was very mild ... but there were a few that had frank cirrhosis and they didn’t know. Here’s the scariest part: one of the sickest was a 21-year-old woman. ... If you get this for free at age 20, it is very different. If you don’t get this and you go on with your life, at age 50, you may have cancer.”
Over the course of 2.5 days, de Groen and his team, including Jaber Salem, clinical researcher, recruited participants at the state fair by offering them a questionnaire to qualify them based on risk factors for fatty liver disease – BMI, alcohol intake and presence of diabetes. If a participant had those risk factors, the team conducted an onsite ultrasound for shear wave elastography liver stiffness (SWELS) measurements. Of the 460 visitors who completed the questionnaire, 132 (29%) met inclusion criteria and completed the SWELS; none were aware of any liver disease. Participants received follow up 1 month after the exam.
“Fatty liver disease is in 30% of Americans and there is not a quick way to test and a lot of people don’t know about it. We did this test to see how many people we could get with this quick liver determination,” Salem told Healio Gastroenterology and Liver Disease. “We chose the Minnesota State Fair because it has the largest population in the United States for 5 days.”
“The questionnaire that predicted [risk] was amazingly good,” de Groen added.
Of those 132, 92 had a peak SWELS of more than 6 kPA, making it an abnormal determination. Of those, 40 participants with normal SWELS all responded to a follow-up letter or phone call. Nine of the 40 reported consulting a physician, nine reported being on a diet, four were in an exercise program and one was under treatment.
“If one person in the family starts to live more healthy, then it spreads,” de Groen said.
Of the 92 who had abnormal SWELS, 82 (90%) replied to the follow-up outreach and 59 (72%) reported taking healthcare-related actions. Twenty-nine reported consulting a physician, 39 reported dieting, 23 reported participating in an exercise program, 11 underwent additional liver imaging and eight received treatment. Salem said two reported weight loss of greater than 30 lb, two reported loss of more than 10 lb and two reported loss more than 5 lb.
“They were super ecstatic. It was amazing to hear their voices,” Salem said. “That reaffirmed that we caused patients to go out of their way to change their lifestyle.”
Salem and de Groen plan to follow them further to observe further changes in their lifestyles. Ultimately, de Groen suggested that liver ultrasound with technology like SWELS should be part of vitals screening, even in the primary care setting. Then physicians must monitor patients’ weight very regularly so they can see the change.
“I want this for the new generation,” he said. “To use this more, you have to have a very low threshold for this test. There should be no cost and no reason for the patient not to do it. But you have to be able to support the patient. ... Weight loss is so difficult and the way to change this is to full court press everywhere. ... You can never lose weight alone.” – by Katrina Altersitz
Reference: Salem J, et al. Mo1498. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).
Disclosures: Salem reports no relevant financial relationships. De Groen reports holding a patent for Endometric.