Implementation of the Lancet Standing Commission on Liver Disease in the UK

New metrics for the Lancet Standing Commission on Liver Disease in the UK

“…The Lancet Commission publications have provided several recommendations with relevance to primary care. 10,14 In 2016, the Royal College of General Practitioners (RCGP) selected liver disease as a one of their clinical priority programmes, 15 and, in partnership with the British Liver Trust, it has recently appointed a primary care Clinical Champion for Liver Disease. 16 This builds in part on the RCGP Nutrition for Health clinical priority programme (2011-15), whose RCGP nutrition position statement clarified the need for greater primary care action on obesity and the role of obesity as a risk factor for liver disease.…”

“…14 Bold investment plus innovative local commissioning initiatives will be needed if traditional areas of secondary care management, such as hepatitis C treatment, are to feature more in primary care as the price of new antiviral drugs falls and arrangements through the operational delivery networks become less necessary. Innovations require a full and realistic awareness of the large number of patients at risk of and with early liver disease, and the multiple competing workload pressures that already exist within primary care.…”

Prevalence of clinically significant liver disease within the general population, as defined by non-invasive markers of liver fibrosis: a systematic review

“…Due to the increasing morbidity and mortality of chronic liver disease there is a necessity for urgent action to be taken to prioritise the earlier identification and treatment of patients, particularly within the community (6). Commonly used diagnostic tests have poor sensitivity and specificity, are completed opportunistically or are not appropriate to be used within a community setting therefore limiting the opportunities for intervening at an earlier stage in the disease.…”

Toxic AGE (TAGE) Theory for the Pathophysiology of the Onset/Progression of NAFLD and ALD

“…NAFLD is defined as hepatic steatosis in the absence of significant alcohol intake (an intake of <20 g ethanol/day for women or <30 g ethanol/day for men is acceptable for the diagnosis as NAFLD), not caused by hepatitis B or C virus, autoimmune hepatitis, the use of hepatotoxic drugs or other compounds, or rare genetic forms [22]. NAFLD is currently the most common chronic liver disorder, with an estimated worldwide prevalence of 25% [2,23,24]. Depending on the method of diagnosis, 65–85% of patients with type 2 diabetes mellitus (T2DM) have NAFLD [25,26].…”