In this episode of Rising Tide, co-hosts Ken Cusi and Roger Green return for a closer look into screening, diagnosing and treating Fatty Liver and the impact across metabolic health as an integrated system. They are joined by KOL in hepatology, Manal Abdelmalek and KOL in endocrinology, Scott Isaacs to cover a spate of invaluable ideas relevant to frontline providers.
14:44 Morbidities and Mortalities Related to Fatty Liver Disease
20:47 Paradigm-Shifting Data Points
26:23 Screening for Risk Stratification
32:09 Pediatric and Adolescent Populations
46:35 Key Takeaways for Frontline Providers
Among the plethora of takeaways gleaned in this session, the panelists expand at depth on the following major themes:
14:44 Morbidities and Mortalities Related to Fatty Liver Disease
Roger introduces the idea that Fatty Liver is an independent predictor of many forms of morbidity and mortality. He notes that not only is it related to cirrhosis and hepatocellular carcinoma (HCC), but also leads to increased rates of non-hepatic cancers and complications in cardiovascular disease amongst a myriad of other negative outcomes. Ken explains that his attention was seized as an endocrinologist when he began learning that liver disease was majorly contributing to the rise of Type-2 diabetic patients arriving at his clinic. In addition to new-onset diabetes, Manal adds that the growing affirmation around increased risk of cardiovascular and kidney diseases greatly extends call-to-action beyond hepatology. Finally, Scott underscores the need for frontline providers to persist in the early identification of Fatty Liver as an independent predictor despite dwelling in an entanglement of interrelated conditions.
20:47 Paradigm-Shifting Data Points
Roger asks the panelists to recall a moment in time when each became motivated by an outstanding data point. For him, this came in the form of learning that 30% of HCC in Fatty Liver disease presents earlier in progression as opposed to solely F4 patients. Manal harkens to the encumbrance of Hepatitis C from a public health perspective, noting the toll of Fatty Liver to be exceedingly larger by a magnitude of 10-times the burden. Roger suggests that those who aren’t studying this disease may underestimate the breadth of its impact. He reasons that one would assume the largest issues receive the most attention, however are not in the instance of liver disease and public health. Scott returns to the idea of nonlinear progression to HCC as a source of motivation for patients and providers to prioritize liver health. Ken points to emerging data suggesting that the staggering incidence of Fatty Liver may be twice as high in endocrine clinics than in primary care. His key takeaway for the listeners: pharmacotherapy for obesity and Type-2 diabetes needs to be utilized today. Referring patients to nutritionists and getting them on structured weight loss programs are also critical steps to amplify.
26:23 Screening for Risk Stratification
Roger asks the panelists whether there are markers which indicate susceptibility to Fatty Liver disease and its complications. He questions whether any marker is trustworthy enough or should all patients be screened with vigilance regardless. Ken suggests that in diabetes clinics, the degree of Fatty Liver progression can be extremely difficult to predict with any consistency. It’s therefore critical to risk stratify and “know where that patient is” in order to take aggressive action once progression is identified. Manal elaborates on the balance of injury and repair as it relates to liver disease. She notes that patients who have NASH and necroinflammation in the liver with fibrotic liver injury are the ones at highest risk for renal disease, new-onset diabetes, cardiovascular complications and other drivers which trigger an inflammatory response to metabolic stress. In her words, “injury begets more injury.” Scott points to the opportunity of treating those with multiple risk factors with pharmacotherapies available today, like GLP-1s and pioglitazone, to holistically improve metabolic condition.
32:09 Pediatric and Adolescent Populations
Roger steers conversation to consider what frontline providers can do to address the increasing incidence of NAFLD and NASH in the pediatric and adolescent population. Ken quickly links the compounding consequences behind younger generations with exploding rates of obesity and Type-2 diabetes. Scott adds that awareness around the issue is not present among the providers and with teenagers themselves. Manal shares her reality that “it is not uncommon to see older adolescents or even patients in their twenties with advanced hepatic fibrosis or cirrhosis” in the hepatology clinic. The group exchanges ideas around intervention and the importance of maintaining a healthy weight.
46:35 Key Takeaways for Frontline Providers and the Imminent Future of Fighting Fatty Liver
As the session winds down, Roger prompts the panelists to elaborate on some unique pieces of advice and recommendations to physicians and frontliners that may not be common knowledge at this time. Each offers insight-laden responses that round off a cogent and motivating discussion.
If you enjoy the episode, have questions or interest around its contents, we kindly ask that you spread the word and help us put a major dent in Fatty Liver disease. We also encourage our audience to write us questions and look forward to integrating your on-ground perspectives in the discourse.
This podcast series and all episodes are produced under a non-restricted grant from Novo Nordisk. Novo Nordisk has neither influenced nor reviewed the contents of this podcast in any way. This content represents the views of the speakers and does not necessarily represent the views of Novo Nordisk. The content herein is for educational purposes only and should not be taken as medical advice.
