Liver screening at health clinics can save lives, according to pilot study in Rhode Island

PROVIDENCE, R.I. [Brown University] - People from groups most affected by liver disease are often unaware of their diagnosis until it has already reached an advanced stage.

To preempt that challenge, researchers from the Brown University School of Public Health conducted a study that screened patients for liver disease and associated risk factors during visits to a community health clinic, and then offered various forms of counseling. The pilot study, which included 14 people, identified three participants with liver stiffness and eight with liver disease, and provided patients with the opportunity to reverse the damage they didn't realize they had.

The study was published in Rhode Island Medical Journal and led by Hayley Treloar Padovano and Mollie Monnig, psychologists affiliated with Brown's Center for Alcohol and Addiction Studies. Treloar Padovano, who holds associate professor roles at Brown's School of Public Health and Warren Alpert Medical School, says the best path for addressing liver disease is to identify the issues early and change behavior around alcohol use and diet.

"One of the biggest factors causing disparities in who progresses to the most severe liver disease and then eventually dies waiting on transplant lists is they were not diagnosed early enough and never offered appropriate treatment," Treloar Padovano said.

Steatotic liver disease, which involves an accumulation of excess fat in the liver, can lead to inflammation and damage and is often linked to metabolic issues like obesity, diabetes and high cholesterol, as well as alcohol use.

Liver disease is preventable with lifestyle modifications, the authors said. But associated risks like obesity and diabetes are on the rise, and without intervention, deaths caused by chronic liver disease will double by 2040, with populations experiencing health disparities hit the hardest.

"There is a critical, unmet need for integrated interventions that are culturally relevant and delivered through existing community health care systems to reduce disparities via early disease detection and connection to life-saving care," Treloar Padovano said.

On-site screening for an often invisible health issue

To conduct the study, the team partnered with Clínica Esperanza, a nonprofit clinic that provides high-quality, culturally and language-attuned health care to uninsured adults in Rhode Island.

Over 11 months, the study involved a two-stage screening process, incorporated into the clinic's onboarding process, to target adults over the age of 21 with multiple health risk factors. The researchers reviewed electronic health records to identify patients with body mass index of 25+ and who scored at-risk on a test assessing alcohol use disorder. Adults who met the criteria received behavioral screening at the clinic as well as diagnostic imaging using a FibroScan device that detects liver stiffness and fat accumulation.

Preliminary pilot data identified liver stiffness (fibrosis) in 21% of participants and steatosis in 57%. None of the identified patients had been previously aware of their condition.

A psychologist on the study team met with participants, who were randomly selected to receive either brief advice or a type of counseling referred to as motivational interviewing, to discuss their risk factors for liver disease. Participants were connected to resources such as clinic programs that promote substance use reduction and cardiometabolic health, and patients with significant FibroScan findings had results provided to their health care team.

A key finding of the study was that providing personalized feedback from clinic diagnostics can reduce biobehavioral risk factors and prevent the progression of liver damage to advanced disease, said Monnig, an associate professor of behavioral and social sciences at Brown.

"Although the intervention lasted only 30 days, the qualitative feedback from patients was very strong," Monnig said. "Many expressed surprise at the condition and gratitude for feeling empowered to do something about it."

The researchers concluded that integrating on-site diagnostics with culturally attuned behavioral interventions in a community-centric clinic can bypass traditional barriers to care and detect "silent" liver disease at treatable stages.

"Patient exit interviews from our small study showed that even with a brief intervention, you can really change people's perspectives and behavior to help them lower their risk of liver disease," Treloar Padovano said.

The researchers are applying for funding to conduct a randomized control trial to assess the program's effectiveness on a larger scale.

The project was funded by the National Institutes of Health as a Team Science supplement to the Center for Addiction and Disease Risk Exacerbation at Brown's School of Public Health. The research team also included Dr. Kittichai Promrat, a gastroenterologist and hepatologist with Brown University Health's Center for Inflammatory Bowel and Liver Disease, and Stephanie Goldstein, an associate professor of psychiatry and human behavior (research) at Brown.