Making up for Lost Time in Liver Disease

[Jeffrey V Lazarus is head of the Health Systems team at ISGlobal and vice-chair of the board of the EASL International Liver Foundation].

June 12 - International NASH Day

It is near impossible to capture in words the impact the COVID-19 pandemic has had across the world. Doubtless, governments and healthcare organizations will debate the human and economic toll of the pandemic for years to come. When COVID-19 first emerged, there was a concerted effort on the part of governments and healthcare systems to redistribute and redirect resources to the front line.

The impact on people in long-term care, those with chronic conditions that require management and intervention in the absence of curative treatments, was felt immediately. With each wave of the pandemic, the disruptions to care services occurred as most governments failed to set in place systems that would continue to protect people with long-term conditions.

With each wave of the pandemic, the disruptions to care services occurred as most governments failed to set in place systems that would continue to protect people with long-term conditions

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have historically been overlooked conditions, despite being the most common chronic liver diseases in high-income countries. With few symptoms in the early stages, left unchecked the impact severely worsens, potentially leading to cirrhosis, liver cancer, and an increased risk of cardiovascular disease and type 2 diabetes mellitus.

Many will agree that management of long-term conditions is an area that has failed people during the COVID-19 pandemic. Now, as the world tries to build back and we reflect on the failures and successes of the pandemic response, there is an urgent need to reinvent management systems for long-term conditions so that they can weather national and global emergencies like the current pandemic.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have historically been overlooked conditions, despite being the most common chronic liver diseases in high-income countries

Missed opportunities in NAFLD/NASH

For people with NAFLD or NASH, the lack of access to routine care was compounded by a host of other issues. Few healthcare settings have established comprehensive models of care for the management of NAFLD. Dietary and fitness lifestyle changes remain the core element of NAFLD management, yet the pandemic has made these more difficult. It has increased stress, led to negative changes in diet, and lessened physical activity for almost everyone, not just people living with long-term conditions.

People with NAFLD or NASH are among those struggling to manage their condition. A survey conducted during the pandemic found that physicians who managed patients with NASH generally failed to see it as a priority condition. The lack of priority placed on NASH as a serious condition was widespread, with only 15% of patients successfully implementing the lifestyle changes recommended by their doctor.

The needs of people living with chronic liver diseases were already overlooked before and during the pandemic – few, if any, effective solutions were implemented, leaving patients increasingly without care. As restrictions are now gradually being lifted in Europe and healthcare services are resuming a near-normal course, it is likely we will see the pandemic take its toll once again and a surge in people presenting with NAFLD or NASH symptoms will require our attention. It is now that we need to prioritize NAFLD and NASH and ensure diagnosis and management of chronic liver diseases are taken to the next level.

The needs of people living with chronic liver diseases were already overlooked before and during the pandemic– few, if any, effective solutions were implemented, leaving patients increasingly without care

The pandemic has emphasized the need to build awareness about NAFLD outside of the liver health community, from healthcare providers to non-communicable disease (NCD) groups and policy makers. Over the past 12 months there have been encouraging signs. The Economist Intelligence Unit and EASL International Liver Foundation (EILF) along with experts from Asia, Latin America and the Middle East recently set out how to advance the NAFLD agenda in these regions. In December 2020, the first global public health dialogue on NAFLD was also convened by Wilton Park and EILF. As we look forward, we need to build on this momentum.

Building back better

There is a wealth of changes that could be made to help improve and manage NAFLD and NASH. As part of the outcomes of a European NASH patient survey which will be presented at EASL’s International Liver Congress later this month, we discuss multiple gaps where simple solutions can be implemented to improve long-term care. Many of these solutions, including in the realm of digital health, transcend liver health and would enable us to build a better future for all NCDs.

There is a wealth of changes that could be made to help improve and manage NAFLD and NASH

It is time to really listen to people with conditions such as NAFLD and NASH and transform insights into actions. Together, we can improve the quality of life of people living with chronic liver diseases.