Could GPs soon be detecting hidden liver disease, simply by shaking a patient’s hand?
While social distancing means it’s currently barred, it is a real prospect raised by new research that shows a limp handshake or a weak grip is an early warning sign of a potentially fatal condition called non-alcoholic fatty liver disease (NAFLD).
Thought to affect up to one in three adults in the UK, NAFLD is a build-up of fat in the liver, usually triggered by an unhealthy diet and sedentary lifestyle, rather than heavy alcohol consumption.
Left unchecked, it can — over several years — cause severe inflammation and scarring of the organ, which increases the risk of liver cancer and liver failure.
Limp handshake? GPs could soon be detecting hidden liver disease, simply by shaking a patient’s hand
Yet, while it is surprisingly common, NAFLD can be hard to detect, as there are few external signs and no obvious symptoms during the early stages.
Most people with the condition have no idea they are affected. A healthy liver should contain no fat, yet, in many cases, although the person may be slim, they still have deposits of fat in the liver.
Often, the condition is only picked up through routine blood tests for something else. By the time they experience any symptoms — such as dull pain in the top right of the stomach and extreme fatigue — the condition has already progressed and often irreversible damage has occurred.
However, new research suggests that the strength of someone’s handshake could give doctors a clue as to whether the patient is in the early stages of NAFLD. The breakthrough could provide a chance to intervene before the liver suffers irreversible damage — research shows NAFLD can be reversed if caught in the early stages, just by losing around 10 per cent of body weight.
Even people who do not drink can develop liver disease through unhealthy lifestyle choices
Scientists at the University of Auckland in New Zealand studied almost 4,000 men and women, mostly in their 40s.
Each one had their grip strength measured using a hand-held device called a dynamometer, which has a sliding lever that is pulled backwards.
The patient squeezed the gadget three times with both hands and an average was taken.
Scientists then used a scoring system deployed by liver specialists all over the world to identify cases of NAFLD. It calculates the risk of having the condition based on clinical features, including body mass index, insulin readings and blood sugar levels. Those who scored highest then had ultrasound scans to see if there was fat in the liver, indicating they had the disease.
The results, published recently in the European Journal of Clinical Nutrition, found those with the weakest grip were almost twice as likely to have fat in their liver. And, the weaker the grip, the higher the fat levels.
The findings support those of a similar study in South Korea in 2019. It discovered that people with NAFLD had hand-grip scores averaging eight per cent less than those with healthy livers. But why would our ability to squeeze things be a window into the state of our liver?
Grip strength varies considerably throughout our lives, peaking in our late 20s, before declining as we age. For example, a man aged 25 to 30 should score 40-50kg on a grip-strength test — meaning they can clench those weights with their hand — and a woman of the same age, 25-30kg. But, by the time they reach 70, this will have dropped to 35-40kg for a man and around 20kg for a woman.
That’s because of sarcopenia — a gradual loss of muscle mass and strength as part of ageing.
But sarcopenia is emerging as a red light for a range of health conditions — including heart disease, lung problems and even depression — where loss of strength is thought to be an early indication of developing problems.
The Auckland team think that fatty livers damage grip strength by causing low-level inflammation in the body that weakens muscles and reduces their mass.
Their findings could be significant because, left unchecked, this disease turns into a more serious condition called non-alcoholic steatohepatitis, or NASH. This is where scar tissue forms and the liver becomes seriously inflamed — heightening the risk of liver failure (where it stops working and a transplant may be needed) or cancer.
An estimated three million people in the UK have NASH, and around one in 12 will die within seven years of their diagnosis.
British liver experts said the findings suggest grip strength might be a useful indicator of hidden problems, but might not be enough on its own to confirm a NAFLD diagnosis.
Professor Roger Williams, who is director of the Institute of Hepatology in London, says: ‘It would not be a specific diagnosis of NAFLD. But it could be used as a marker of severity.