Fatty Liver Disease- Managing the Epidemic

More Nova Scotians are affected by fatty liver disease than the global average.
More Nova Scotians are affected by fatty liver disease than the global average.

Fatty liver disease has reached epidemic proportions in Nova Scotia.

“I see 20 or more new patients with advanced inflammatory fatty liver disease every week,” said Dr. Magnus McLeod, an internist who specializes in liver disease. “Two nurse practitioners see five to ten less severe new patients a week.”

Rising rates of fatty liver disease mirror the epidemic of obesity and diabetes worldwide.

“It’s estimated that 25 per cent of adults around the globe have fatty liver disease,” noted Dr. McLeod. “In Nova Scotia, an estimated 35 to 40 per cent of the adult population is affected.”

As many as 25 per cent of patients with fatty liver disease have the inflammatory sub-type known as NASH—non-alcoholic steatohepatitis—which can lead to scarring in the liver. Left untreated, this can progress to cirrhosis and liver failure, with transplant the only route to survival.

Dr. McLeod and Dr. Kevork Peltekian, hepatologist and head of the Division of Digestive Care & Endoscopy, are leading NSHA’s involvement in several international clinical trials of potential therapies. These include trials of new medications designed specifically for NASH, as well as studies to see if drugs used to treat diabetes could also help prevent the progression of fatty liver disease.

“There are so many factors involved, from insulin resistance, to bile acid regulation, to the gut microbiome… a cocktail of agents may be required,” said Dr. McLeod. “Every patient is different… ultimately we’re looking at personalized medicine.”

If fatty liver disease is diagnosed early enough—before it progresses to the inflammatory stage that accelerates scarring and leads to cirrhosis—it can be halted and even reversed with weight loss and lifestyle changes. The challenge is twofold: most patients are unable to lose the weight and keep if off, and it is difficult to accurately pinpoint the stage of disease and monitor its response to treatment.

“Liver biopsy is the current gold standard, because blood tests of liver enzymes give high rates of false positives and false negatives,” Dr. McLeod explained. “We have a fibroscan that uses ultrasound and other vibration waves to measure liver elasticity, but we’re collaborating with radiology to develop far more precise measures.”

Dr. Peltekian and Dr. McLeod send patients to radiologist Dr. Sharon Clarke, who has an Atlantic Innovation Fund award with BIOTIC to create MRI algorithms that reveal detailed information about the amounts and kinds of fat in the liver and the risk of serious progressive disease.

“These tools will dramatically improve our ability to reduce the toll of fatty liver disease,” said Dr. McLeod, who is also developing a program to help motivated patients lose weight.