Fatty Liver Disease-Chewing thru the Fat!

As an underwriter, it is common to review medical records indicating a history of "benign fatty liver disease" - especially in those patients with history of high BMI's that carry the majority of their weight through the mid section. Often times, there will be correlation to mildly elevated liver enzymes in a serum blood draw. In a number of underwriting assessments this finding, absent of any alcohol or hepatitis concerns, is typically treated as a non-debitable situation.

A recent research study has focused on the usefulness of utilizing specific laboratory panels to better identify non-alcoholic fatty liver disease (NAFLD) vs. advanced stage non-alcoholic steatohepatitis (NASH). The latter carrying a much higher rate of mortality impact from increased liver disease complications.

The study conducted on 541 patients in the NIH-funded NASH clinical research network found that there was correlation between specific lab/body habitus and biopsy proven advanced stage NASH. Specific areas of importance included; BMI, AST/ALT ratio, AST/platelet ratio, BARD score (BMI, AST/ALT ratio, diabetes), and cirrhosis discriminant score. Unfortunately, lab tests still are unable to clearly identify advanced NASH cases-but these tests are a step in the right direction for identifying situations that require further evaluation.

This will continue to be a problematic issue for underwriting professionals, especially in light of the increasing obesity issues that will affect increased diagnosis of NAFLD making it difficult to weed out those that are higher risk NASH cases.