A recent report found that death rates for chronic liver disease and cirrhosis rose 31% among ages 45 to 64 between 2000 and 2015.The liver performs critical functions, including cleaning toxins from the blood, storing energy and nutrients, digesting fats and processing medications, alcohol and food.
But a host of negative effects can wreak havoc on the liver, from heavy drinking and infection with hepatitis B or C to a scourge known as fatty-liver disease Which linked to diabetes and obesity.
The liver can become fibrous and scarred which eventually develops cirrhosis, the replacement of normal tissue with hard tissue. The damage that occurs increases the risk for liver cancer.
A September report by the Centers for Disease Control and Prevention found that death rates for chronic liver disease and cirrhosis rose 31% among those age 45 to 64 between 2000 and 2015. And cases of liver cancer rose more than 20% between 1990 and 2015.
Yet liver diseases often have no symptoms until they are far advanced, making it all the more important to identify and test those at risk.
“With baby boomers, we may focus on heart disease, dementia and cancer, and don’t always think about the liver,” says Dr. Anna S. Lok, director of hepatology at the University of Michigan and president of the American Association for the Study of Liver Diseases.
There are new drugs that cure hepatitis C, and a number of treatments are in development for advanced fatty-liver disease. Getting and staying sober can reverse liver damage caused by alcohol, and losing weight can reverse damage caused by nonalcoholic liver disease.
“The liver is very forgiving and can bounce back even in early stages of cirrhosis,” says Lok. Once cirrhosis is advanced, however, the only option is a liver transplant, which can be hard to come by. There are new treatments for liver cancer if diagnosed early, so screening cirrhosis patients for liver cancer is important, she says.
Testing barriers
According to a study published last month in JAMA Oncology, the rise in liver cancer in the U.S. is partially due to hepatitis C infection in baby boomers. An estimated 1 in 30 have been infected with the virus, the second-leading cause of cirrhosis.
Hepatitis C was often transmitted during medical treatment before infection-control procedures were widely adopted, or from blood transfusions before 1992, when screening for the virus virtually eliminated such risks.
It can also spread among intravenous-drug users, even with just one use, and from unsterilized tools at tattoo cafes.
In 2012, the Centers for Disease Control and Prevention recommended a one-time hepatitis C test for all adults born between 1945 and 1965. But fewer than 30% have actually been tested, according to estimates. Doctors may fail to ask patients about past medical procedures or drug-use history, and patients may either be unaware of possible medical exposures or be hesitant to mention risky behavior such as intravenous-drug use.
“Patients who are now respectable citizens may not want to tell their doctors, ‘I was a crazy teen back in the ’60s,’ ” Lok says.
To eliminate such barriers, Lok and colleagues have designed an electronic-health-record alert that prompts primary-care physicians to perform such screenings if patients who are baby boomers haven’t yet been diagnosed or tested.
In a study published in the journal Hepatology in September, the team said hepatitis C testing rates increased fivefold, to 72% among those born between 1945 and 1965, in the year after the electronic alerts were launched. Of 53 newly diagnosed patients, 11 had advanced fibrosis or cirrhosis, 20 started treatment and so far nine have been cured.
If you are overweight or have Type 2 diabetes, you may be at risk of fatty liver disease.
The first sign of liver disease may be elevated liver enzymes in a blood test. Dr. Elliot Tapper, an assistant professor at University of Michigan who treats patients at its clinics and at the Ann Arbor VA hospital, says issues related to alcohol, obesity and diabetes are the most likely cause, followed by hepatitis B or C. Tests for such conditions should be used first, including an ultrasound of the liver to look for fatty-liver disease.
If patients disclose they drink excessively or use intravenous drugs, or are taking a drug or dietary supplement that can cause liver damage, the need for more invasive tests such as liver biopsies to test for rarer conditions falls sharply, Tapper says.
Fatty livers
Fatty-liver disease, a buildup of fat in the liver, affects as many as 100 million Americans, especially those in their 40s and 50s, but also strikes children and young adults. The disease can lead to a progressive form known as nonalcoholic steatohepatitis, or NASH, which can cause scarring that leads to cirrhosis and increases the risk of heart disease, Tapper says. Genetic variations may make some people more vulnerable.
While liver biopsies are still used to definitively diagnose liver diseases and determine their stage, noninvasive tests using different types of scans and imaging technology such as MRI are becoming more widely used.
A 2015 study of 100 patients, using such technology, showed that almost two-thirds with Type 2 diabetes have evidence of nonalcoholic fatty-liver disease, while more than 7% have advanced fibrosis. Study author Dr. Rohit Loomba, director of hepatology and a research center devoted to nonalcoholic fatty-liver disease at the University of California, San Diego, says follow-up studies aim to determine whether such technology is cost-effective for wide use.
Until such screening methods are better established, he says, doctors should assess their patients with classic risk factors for fatty-liver disease those in their 40s and 50s at high risk of heart disease because of obesity and diabetes. Fatty-liver disease is also closely linked to metabolic syndrome, a group of abnormalities that include increased belly fat, high blood pressure and high blood levels of triglycerides, a type of fat.
“If you are overweight or obese and have Type 2 diabetes and are 50 or older, you need to ask your primary-care doctor if you might have fatty-liver disease,” Loomba advises.
For patients in midlife who have already piled on extra pounds, or are gaining a few pounds each year, even moderate weight loss can reduce risk and help reverse harm to the liver, he adds.
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