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Weak handshake? You may be at risk for a potentially fatal liver disease

Can GPs soon discover hidden liver disease simply by shaking a patient’s hand?

While social distance means it’s currently being blocked, it is a real prospect raised by new research showing a weak handshake if a weak grip is an early warning sign of a potentially fatal condition called non-alcoholic fatty liver disease (NAFLD) .

NAFLD, which is thought to affect one in three adults in the UK, is an accumulation of fat in the liver, usually caused by an unhealthy diet and sedentary lifestyle, rather than heavy alcohol consumption.

If left unchecked, it can – for several years – cause severe inflammation and scarring of the organ, increasing the risk of liver cancer and liver failure.

Weak handshake? GPs could soon discover hidden liver disease simply by shaking a patient's hand

Weak handshake? GPs could soon discover hidden liver disease simply by shaking a patient’s hand

But while surprisingly common, NAFLD can be difficult to detect, as there are few external signs in the early stages and no obvious symptoms.

Most people with the condition have no idea they are affected. A healthy liver should not contain fat, but in many cases, although the person may be slim, they still have fatty deposits in the liver.

Often the condition is picked up only by routine blood tests for something else. By the time they experience symptoms – such as dull pain in the upper right corner of the stomach and extreme fatigue – the condition has already progressed and irreversible damage has often occurred.

However, new research suggests that the strength of a person’s handshake could give doctors an idea of ​​whether the patient is in the early stages of NAFLD. The breakthrough could provide an opportunity to intervene before the liver takes irreversible damage – research shows that NAFLD can be reversed if caught early, just by losing about 10 percent of body weight.

Even people who don't drink can get liver disease from an unhealthy lifestyle

Even people who don't drink can get liver disease from an unhealthy lifestyle

Even people who don’t drink can get liver disease from an unhealthy lifestyle

Scientists from the University of Auckland in New Zealand studied nearly 4,000 men and women, mostly in their 40s.

Each of them measured grip strength using a hand-held device called a dynamometer with a sliding lever pulled back.

The patient squeezed the gadget with both hands three times and an average was taken.

Scientists then used a scoring system deployed by liver specialists around the world to identify cases of NAFLD. It calculates the risk of having the condition based on clinical features, including body mass index, insulin measurements, and blood sugar levels. Those who scored highest then had ultrasounds to see if there was fat in the liver, indicating that they had the disease.


Non-alcoholic fatty liver disease is caused by too much fat being stored in the organ cells.

The disease can cause scarring and irreversible damage to the liver and can lead to cirrhosis (scarring) and organ failure.

Fatty liver disease usually doesn’t cause signs and symptoms, but they can include an enlarged liver, fatigue, and abdominal pain.

The disease is caused by obesity, insulin resistance, high blood sugar and high blood fat.

The risk of contracting the disease is increased in people with high cholesterol, concentrated abdominal fat, sleep apnea and type 2 diabetes.

A nutritious diet, maintaining a healthy weight and exercising regularly can reduce the risk of fatty liver disease.

Source: Mayo Clinic

The results, recently published in the European Journal of Clinical Nutrition, showed that 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 content.

The findings support those of a similar study in South Korea in 2019. It was found that people with NAFLD had, on average, 8 percent less handle scores than people with healthy livers. But why would our ability to squeeze things be a window on the condition of our liver?

Grip strength varies significantly throughout our lives, peaking in the late 20s, before decreasing as we age. For example, a man aged 25 to 30 should score 40-50 kg on a grip strength test – meaning they can clamp those weights with their hand – and a woman the same age, 25-30 kg. But by the time they turn 70, this has dropped to 35-40 kg for a man and about 20 kg for a woman.

That’s because of sarcopenia – a gradual loss of muscle mass and strength as part of aging.

But sarcopenia emerges as a red light for a range of health problems – including heart disease, lung problems, and even depression – that loss of strength is believed to be an early indication of developing problems.

The Auckland team thinks fatty livers decrease grip strength by causing a low level of inflammation in the body that weakens muscles and reduces their mass.

Their findings could be significant because, if unchecked, this disease turns into a more serious condition called nonalcoholic steatohepatitis, or NASH. Here, scar tissue forms and the liver becomes severely inflamed – increasing the risk of liver failure (where it stops working and may require a transplant) or cancer.

An estimated three million people in the UK have NASH, and about one in 12 die within seven years of diagnosis.

UK liver experts said the findings suggest that grip strength may be a useful indicator of hidden issues, but may not be enough to confirm an NAFLD diagnosis.

Professor Roger Williams, director of the Institute of Hepatology in London, says, “It wouldn’t be a specific diagnosis of NAFLD. But it can be used as a sign of seriousness.