Letter: Enhancing cirrhosis management—The critical role of social workers in supporting NAFLD surveillance: Authors' reply

Abstract

We thank Ye et al. for their thoughtful comments on our recent study.^{1, 2} While we agree with their suggestions for expansion of the study cohort characteristics using other databases to augment our study, this was beyond the scope of this study but is something that can be considered for future studies. In this context, we did acknowledge the limitations of our study to include the potential for undercoding or miscoding of cirrhosis and that our study population was only those who had private insurance which may limit the generalizability of our study results.¹ However, as Ye et al. pointed out, those from low income and low education backgrounds are more likely to have chronic liver disease (CLD) and cirrhosis, which with the addition of Medicaid data, would most likely have made our trends even more pronounced especially for nonalcoholic fatty liver disease (now known as metabolic dysfunction-associated steatotic liver disease, MASLD) and alcohol-related liver disease (ALD).³ As has been recently reported, MASLD and ALD are the two main drivers of CLD with those from low income and low education more likely to have an increased burden of disease.⁴

On the other hand, a major strength of the study was our ethnic breakdown by liver disease. This information can be used by communities to develop targeted interventions for the liver disease most likely to be prevalent in their communities.⁵ While we also agree that social workers can play a pivotal role in community-based screening, at this time, screening for MASLD is not cost effective.^6-8 Nonetheless, screening for what is considered high risk MASLD, those with fibrosis stage 2 or greater, may be cost effective and help decrease disease progression to cirrhosis and other adverse outcomes.⁸ However, the identification of those with high risk MASLD has many barriers to include low awareness, lack of available non-invasive tests and, until recently, lack of treatment outside of diet and exercise.⁷ As a new drug, resmetirom has now come to market for treatment of MASLD with fibrosis stages 2 and 3, there is a renewed interest on identifying high risk patients.⁹ Therefore, it is apparent that community-based actions for MASLD should be centred on persons most at risk for having MASLD (being obese, having type 2 diabetes, presence of metabolic syndrome) to increase awareness of this CLD and what interventions are now available to help individuals who may be at risk of having MASLD in order for them to seek care for further evaluation.¹⁰

We appreciate Ye et. al.'s article highlighting the importance of all healthcare workers working together to not only reverse the growing prevalence of MASLD and its adverse outcomes but also of other CLDs that may be more prevalent in some communities given their ethnic composition.

Sally Tran: Writing – review and editing; project administration. Linda Henry: Writing – original draft. Mindie H. Nguyen: Supervision; writing – review and editing.

No external funding to disclose.

This article is linked to Tran et al papers. To view these articles, visit https://doi.org/10.1111/apt.18024 and https://doi.org/10.1111/apt.18245.