Rising cirrhosis incidence and mortality in the United Kingdom has been attributed predominantly to excess alcohol consumption.
However, metabolic risk factors such as Type 2 diabetes and obesity may also be important.
To screen at-risk individuals in general practice for undetected cirrhosis using transient elastography and study the risk factors underlying these cases.
Dr Harman and colleagues investigated 4 general practices between 2012 and 2014.
Patients with defined risk factors for chronic liver disease (hazardous alcohol use and/or Type 2 diabetes were identified from the General Practice electronic records and invited for transient elastography.
Elevated liver stiffness was defined as 8 kPa.
|26% of patients had elevated liver stiffness|
|Alimentary Pharmacology & Therapeutics|
Cirrhosis was confirmed by established histological, radiological and biochemical methods.
The team invited 2368 patients were invited for transient elastography, and 98% who attended had valid measurements.
Of these, 26% of patients had elevated liver stiffness, and 3% had cirrhosis.
Risk factors for new cirrhosis diagnoses were obesity and/or Type 2 diabetes in 59% of patients, alcohol alone in 11% and both alcohol and obesity and/or diabetes in 30%.
The researchers noted that the presence of cirrhosis was significantly increased in obese patients with Type 2 diabetes or hazardous alcohol use compared to non-obese.
Dr Harman's team concludes, "The number of new cases of cirrhosis diagnosed clearly demonstrates that existing estimates of prevalence are likely to be gross underestimates."
"Obesity was an important risk factor for cirrhosis within both alcohol users and diabetics."