NAFLD prevalence is an increasing topic of conversation and concern. Some refer to it as “the new pandemic.” The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide is a new podcast dedicated to focusing on prevalence, severity and downstream health implications for patients with Type 2 Diabetes and other metabolic diseases. This conversation centers around a segment of the first episode in the series that addressed the unique place for endocrinology practices in screening and identifying Fatty Liver patients.
NAFLD Prevalence and Type 2 Diabetes in an Endocrinology Clinic: The Need for Screening and Vigilance
The first study he mentions is an analysis of NHANES data published in Obesity, lead author Dr. Diana Barb. Dr. Barb and colleagues looked at over 800 patients and reported that simply being overweight with concomitant T2D doubles the probability of NASH and that as BMI rises from 30 to 35 to 40, most people will have steatosis and most of these will have NASH.
This episode starts with Fatty Liver Researcher and endocrinology key opinion leader Ken Cusi praising Stephen Harrison’s prospective NAFLD prevalence study and noting how closely Type 2 Diabetes Mellitus (T2D) and Fatty Liver disease are linked. Ken starts by pointing out that that estimates of NAFLD Prevalence among patients with T2D run as high as 70%. He shares the two primary foci of his research and writing to date: how to use existing anti-diabetes medications to treat Fatty Liver disease alongside T2D, and doing a better job of finding the people who we need to treat, much as we look for kidney disease, eye disease and neuropathic disease.
Ken goes on to note that the rate of NASH in people with T2D and other metabolic conditions might run as high as 46-50%. Many of these patients are obese and have poorly controlled T2D. He goes on to site his second study, conducted in clinics at the University of Florida with over 600 patients, which assessed T2D patients for NAFLD and NASH using VCTE (FibroScan) measurements. This study showed fibrosis in 20-21% of patients studied and 15% with F2 NASH or higher. More important, it showed that the incidence of steatosis and fibrosis was twice as high in endocrinology clinics than it was in primary care settings. These patients have likely had NASH for a longer period of time, which means greater potential for organ damage.
Stephen Harrison asks Ken is there is a correlation between how long the patient has been diabetic and/or level of HbA1c. Ken reports that there are no demonstrated correlations with either variable.
As the session ends, Kay Pepin asks whether there is something simple we can do to screen patients effectively in a world where 15% of diabetics or more have fibrosis and are on the path to potentially devastating disease. Ken notes that initially screening all T2D patients with a FIB-4 test will do a fairly good job of negative prediction and that patients with a high enough level of FIB-4 can be screened further. As guidelines from the various medical societies begin to promote Fatty Liver screening guidelines and multi-specialty clinical care pathways, the idea of an initial FIB-4 screen comes to the fore.