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S2-E2 - A Deeper Dive Into Fatty Liver, NAFLD and NASH

S2-E2 – A Deeper Dive Into Fatty Liver, NAFLD, and NASH

In this episode of the Rising Tide series for frontline professionals, the patients themselves and caregivers, co-hosts Ken Cusi and Roger Green are joined by KOL in hepatology, Manal Abdelmalek and KOL in endocrinology, Scott Isaacs for a deeper dive into Fatty Liver, NAFLD and NASH. The group discusses: morbidities and mortalities related to fatty liver disease, paradigm-shifting data, screening for risk stratification, pediatric and adolescent populations, unique key takeaways and much more.

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.

S2-5 – Key Insights from the American Diabetes Association 83rd Scientific Sessions

Ken Cusi and Roger Green are joined by family practice researcher and KOL Eric Johnson and diabetologist and primary care KOL Jay Shubrook in a discussion around exciting news emerging from the ADA 83rd Scientific Sessions meeting. Layering in practical takeaways, the group explores their impressions from the meeting, the utility of FIB-4 as a frontline screening tool, guidelines and recommendations, therapeutic options both now and in the imminent future, and lastly the new nomenclature rollout for Fatty Liver disease.

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S2-E3 – Why Clinical Care Pathways Matter

In this episode of the Rising Tide series, co-hosts Ken Cusi and Roger Green are joined by KOL in public health, Jeff Lazarus, and physician and associate professor of internal medicine, Jeff Budd. The panelists focus on why clinical care pathways matter and drive the message that primary care plays an integral role in fighting fatty liver.

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S2-E2 – A Deeper Dive Into Fatty Liver, NAFLD, and NASH

In this episode of the Rising Tide series for frontline professionals, the patients themselves and caregivers, co-hosts Ken Cusi and Roger Green are joined by KOL in hepatology, Manal Abdelmalek and KOL in endocrinology, Scott Isaacs for a deeper dive into Fatty Liver, NAFLD and NASH. The group discusses: morbidities and mortalities related to fatty liver disease, paradigm-shifting data, screening for risk stratification, pediatric and adolescent populations, unique key takeaways and much more.

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S2-1 – Combating Swelling NAFLD and NASH Prevalence: Drugs, Diagnostics and Guidelines for the Frontline

In the Season 2 debut of the Rising Tide series for healthcare professionals who treat diabetic patients, the patients themselves and their caregivers, co-hosts Ken Cusi and Roger Green are joined by Mazen Noureddin to talk about prevalence and taking action on the frontlines today. The trio explore emerging NASH drugs, noninvasive testing and guidelines for treating different stages of disease progression.

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S1-E2 — What’s Behind The New AACE Fatty Liver Guidelines?

Drs. Mary Rinella, Zobair Younossi and Diana Barb join co-hosts Dr. Ken Cusi and Roger Green to explore the new AACE Fatty Liver guidelines. Learn about the epidemiology and research behind the guidelines and what they recommend for endocrinologists, primary care physicians and allied health professionals when screening, diagnosing and managing Type 2 Diabetes patients for Fatty Liver disease.

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S1-E1.1 – Fatty Liver Prevalence May Be Higher Than Previously Thought, Especially Among Type 2 Diabetes Patients

Hepatology Researcher and Key Opinion Leader Stephen Harrison discussed results of his 2021 publication in the Journal of Hepatology that reported, in a prospective random sample of 835 people with a median age of 55, NAFLD prevalence as being 37%, NASH as being 14% and advanced fibrosis as being 6% in a random asymptomatic patients. Among patient with Type 2 Diabetes, NAFLD prevalence was 70% and NASH was 35%.

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S1-E1 – New Podcast: Growing NAFLD-Diabetes Dual Prevalence Increases CVD Risk for Diabetics

In this Premier episode of The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide, key opinion leaders Doctors Stephen Harrison, Kathleen Corey and Kay Pepin join co-hosts Dr. Ken Cusi and Roger Green to discuss key issues related to the NAFLD-Diabetes Link, NAFLD-Diabetes Dual Prevalence: very high NAFLD and NASH prevalence in diabetics leads to increased CVD risk and other metabolic issues.

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