As many as one in three adults in Finland have steatotic liver disease (previously known as fatty liver disease), with liver disease also being an increasingly common cause of death. “This threat should be addressed properly, as there are ways to alleviate the situation,” says Ville Männistö, Professor of Gastroenterology at the University of Eastern Finland.
A land of a million cases of steatotic liver disease
Appointed this September, Männistö is one of the two professors in gastroenterology in Finland. According to him, the establishment of the new professorship in Kuopio speaks volumes about how liver diseases are nowadays seen as an important health challenge and focus of research.
Unlike in the rest of Western Europe, liver disease mortality is still growing in Finland. This was demonstrated in a study by Männistö and colleagues, which implicated liver diseases as the cause of death in one in five working-age men.
“Liver diseases are also the most common cause of work years lost to illness.”
Steatotic liver disease is often caused by lifestyles, especially overweight, alcohol use, or both, and partly by genetics. Steatotic liver disease may lead to liver inflammation and scarring, i.e. fibrosis, and eventually to irreversible cirrhosis. It also increases the risk of liver cancer. The disease is problematic because it progresses to an advanced stage without causing symptoms, thus remaining untreated.
“75% of cases of cirrhosis are diagnosed only when liver function is already declining.”
“Prevention would, of course, be best, but the sooner we can detect fibrosis, the better the treatment will work. Active treatment can slow down disease progression, and some fibrosis may even be reversed.”
Earlier diagnostics are supported by a new Finnish liver risk score calculator that can calculate individual risk scores for severe liver-related endpoints, such as death due to cirrhosis. The liver risk score calculator can be found here.
“The calculator should be introduced for routine use in, for example, occupational health care, allowing at-risk individuals to be referred to further examinations.”
“Finland's new Current Care Guidelines for Cirrhosis, which are currently being prepared, will also help to alleviate this disease burden. In addition, this autumn saw the launch of continuing education for liver nurses, enhancing their skills in patient guidance and monitoring.”
Alcohol is more harmful to the liver of those with obesity
Metabolic dysfunction-associated steatotic liver disease is strongly associated with abdominal obesity and metabolic syndrome.
“Our studies show that waist circumference and hip-waist ratio are better than body mass index at predicting the risk of severe liver disease.”
Metabolic dysfunction-associated steatotic liver disease is also associated with a four times higher risk of severe liver disease if the individual also consumes alcohol excessively.
“Steatotic liver disease used to be seen as a disease mainly associated with either obesity or alcohol consumption; however, there is also overlap.”
Metabolic risk factors should be treated also in alcohol-related steatotic liver disease, similarly as alcohol should be avoided in obesity-related disease.
“For individuals with abdominal obesity, one dose of alcohol is as harmful to the liver as four doses are to leaner individuals.”
“Lifestyles are notoriously difficult to change, and people should not be made feel guilty. Luckily however, weight loss of just 5 percent is effective in reducing liver fat. Weight loss of 10 percent starts to reduce inflammation, and even fibrosis.”
Drugs targeting steatotic liver disease are also in the pipeline, but they cannot and should not be prescribed to everyone.
“In some individuals, the disease progresses, while in others it doesn’t go beyond steatotic liver disease, but we still don’t fully understand why.”
This is one of the things Männistö seeks to explore in national and Kuopio-based data, and as part of international research projects. For example, liver biopsy data collected in Kuopio University Hospital have helped to shed light on the genetic risk factors of steatotic liver disease. The liver health of men living in Eastern Finland, on the other hand, is being monitored as part of the wider METSIM study.
“They have recently undergone metabolite profiling, which provides detailed information on changes in different metabolic pathways in steatotic liver disease.”
In addition, patients with cirrhosis from Kuopio University Hospital will be invited to a new follow-up study.
“One aim is to explore how much the course of the disease can be influenced by meticulous optimisation of the treatment.”
As a speciality, gastroenterology focuses not only on the liver, but also on other diseases of the gastrointestinal tract.
“Another major challenge is the growing incidence and prevalence of inflammatory bowel diseases in Finland. A new nationwide study to be launched will explore, e.g., if and how these diseases run in families, their comorbidities and possible regional differences in prevalence,” Männistö says.
Ville Männistö
Professor of Gastroenterology, University of Eastern Finland, 1 September 2024–
- Lic. Med., 2008, University of Kuopio
- Internal Medicine Specialist 2015, MD 2016 and Gastroenterology Specialist 2017, University of Eastern Finland
- Title of Docent in Gastroenterology 2021, University of Eastern Finland
Key roles
- Research Director and Clinical Researcher, University of Eastern Finland, 2022–2024
- Person in charge of gastroenterology specialisation training, University of Eastern Finland and KUH, 2021–
- Postdoctoral Researcher, Academic Medical Center of Amsterdam, 2019–2013
- Specialist, Kuopio University Hospital, 2017–
- Clinical Lecturer, University of Eastern Finland, 2013–2015 and 2017–2019.
For further information, please contact:
Professor Ville Männistö, ville.mannisto@uef.fi, +358447175087, https://uefconnect.uef.fi/en/person/ville.mannisto/
