November 19, 2020
An Effective Approach to Fatty Liver Disease Identification and Management
Non-Alcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) are the most common chronic liver diseases with a direct link to the obesity epidemic. Approximately 25 percent of US adults have NAFLD-NASH according to the American Liver Foundation. Current treatment options are focused on positive lifestyle changes, preferably under the guidance of a healthcare professional. Ideally, lifestyle changes can be implemented early in the natural history of the disease to halt progression and avoid the mortality, morbidity and costs associated with advancing disease. This is where noninvasive diagnostics and telemedicine can help.
NAFLD is an asymptomatic disease until reaching advanced stages when significant health risks exist. Current clinical practice guidelines do not proactively require NAFLD testing, despite clear evidence of high disease incidence in risk factor groups such as type 2 diabetes mellitus (T2DM), metabolic syndrome (MetS) and obesity. More cost effective and clinically efficacious disease management strategies require proactive measures to identify NAFLD patients early and manage progression with lifestyle modification prior to development of cardiovascular, cancer and liver risks.
In this article, we’re going to look at how noninvasive liver diagnostics, digital health and telemedicine can help healthcare professionals cost effectively identify and manage NAFLD-NASH prior to the development of advanced disease. We’re also going to take a closer look at how providers can sustainably provide effective chronic care management.
What is NAFLD-NASH?
NAFLD is a condition involving fat buildup within liver cells, which is termed steatosis. NAFLD, or simple steatosis, does not result in liver damage, but is associated with elevated cardiovascular health risk. Left unchecked, NAFLD can advance to NASH, a condition in which ballooning steatosis and liver inflammation occurs. This process of fat ballooning and associated inflammation frequently results in liver damage and scarring, which is termed fibrosis. In turn, liver fibrosis can progress to cirrhosis and associated risk of liver cancer, portal hypertension and eventual liver failure. Currently cirrhotic NASH is the primary basis of liver transplant in females and is projected to soon become the number one basis for liver transplant in men. In summary, unchecked NAFLD-NASH can have significant mortality and morbidity risks in advanced stages, However, with the implementation of early diagnosis and effective early lifestyle management, these costs and risks are largely avoidable.
What Are Risk Factors of NAFLD-NASH?
The incidence of NAFLD-NASH is highly correlated to type II diabetes mellitus (T2DM), metabolic syndrome and obesity. Based on these co-morbidities, non-invasive diagnostics deployed in these risk groups have significant clinical utility. These metabolic disease associations lend themselves well to an integrated program of noninvasive diagnostics to identify patients who will benefit from a medical nutrition therapy (MNT) and chronic care management.
Graph showing the incidence of NAFLD among primary risk groups (T2DM, Metabolic syndrome and obesity) (Image Source).
How Fatty Liver Disease is Putting Pressure on Healthcare
- NAFLD-NASH is an asymptomatic disease which frequently is not diagnosed or treated in the early stages when low cost, highly effective treatment is possible to stem disease progression.
- Current NAFLD-NASH management programs largely rely on unstructured programs to instill patient lifestyle change, a proposition which is rarely successful.
- Left unchecked, NAFLD-NASH can silently progress to advanced disease with significant mortality and morbidity risks and associated costs.
- NAFLD-NASH is highly correlated with commonly diagnosed conditions such as T2DM, MetS and obesity, thereby clarifying which patients are likely to have disease and will benefit from noninvasive diagnostic strategies.
- FibroScan has well validated capabilities to accurately identify patients with elevated steatosis and fibrosis who will benefit from management.
- The LIVErHEALTHY™ program can assist in reducing risk to patients and creating a manageable approach for a healthy lifestyle. While patients can embark on this on their own, ideally, regular monitoring with a clinician is recommended. For this reason, many healthcare providers are increasingly turning to digital health to help with Chronic Care Management (CCM) of NAFLD, specifically remote care and telemedicine. This in conjunction with Medical Nutrition Therapy (MNT) from ModifyHealth also helps reduce risks. This includes medically tailored meals for patients, dietitian coaching/support and technology for tracking progress. These clinically-proven nutrition programs for multiple GI disease states including NAFLD and NASH are key to any solution.
- Telemedicine is a subset of telehealth. It’s focused on clinical services and education, which it does remotely through technology. Remote Patient Monitoring (RPM) falls under this umbrella as well and involves the real-time monitoring of a patient’s vital statistics (weight, heart rate, glucose levels, sleep patterns, etc.) via various devices. These include wearables (e.g., anklets, sensors, fall detection bracelets) as well as static devices that can be set up in the patient’s environment.
Together, these effective care management strategies empower doctors to detect early disease and monitor patient’s response to disease management. Having this ongoing support also helps patients keep tabs on their own care by giving them access to the data they need.
Telemedicine and RPM are especially useful in caring for patients with multiple chronic conditions because it means they can receive regular digital health support, even if they can’t make it into a doctor’s office.
“New care-delivery platforms and in-home care for chronically ill people can provide community-based, physician-led care to patients who have complex health issues and multiple, specific chronic illnesses,” says Jeff Semenchuk, chief innovation officer at Blue Shield.
Regular, ongoing digital health care makes it easier for doctors to monitor a patient’s health on a long-term basis, while patients can make positive adjustments to their lifestyle under the care and guidance of a professional. With ongoing digital health support for conditions that put patients at risk of NAFLD, doctors are also much more likely to pick up on the early warning signs described above.
Once detected, studies show telehealth can improve self-efficacy in patients with NAFLD. Under the guidance of a professional, NAFLD sufferers are more likely to stick to positive lifestyle changes and achieve a higher quality of life, now and for the rest of their lives.
How Can ChronWell Help?
ChronWell offers digital health services, including telemedicine, Chronic Care Management, and Remote Patient Monitoring. We also partner with Echosens and ModifyHealth with a specific focus on Fatty Liver.
The standard program includes a physician-approved care plan delivered by a team of experts. It also includes 24/7 access to a clinician, with monthly remote catchups that encompass referral management, medication management, and care plan adherence for increased patient satisfaction. LIVErHEALTHY adds additional services and capabilities.
If you’d like to find out more about digital health solutions for chronic conditions, speak to one of our experts today.