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S3-E16.3 – What a Disease Model tells Us About NASH Patient Management

This episode is Sponsored by Resoundant.
Panelists explore several key questions that have arisen at recent meetings like Liver Connect, including the value of waist circumference measurements, the interplay of NAFLD and alcohol consumption and the definition of a "fast progressor."

This conversation explores the impact some suggestions and questions that arose at Liver Connect might have on data modeling. Roger Green starts by mentioning that the Liver Connect panels felt that waist circumference measurement might be a better treatment/diagnostic metric than BMI, since it reflects both fat distributions within the body and region of the world. The group generally agreed that while waist circumference has value in diagnosing and treating individual patients, its relative scarcity of data and inconsistent administration from one practitioner to another (key question: exactly how consistent in the definition of “waist”?) made it a weaker metric than other obesity measures for data modeling.

From there, Alina Allen raised the issue of increased alcohol use and its impact on obesity (not yet measured, but likely to be a serious trend over time with negative impact on longevity and quality of life). During this conversation, the group also explores the value of regressing fibrosis levels vs. simply halting progression (thought: goals should vary based on patient age, fibrosis level and co-morbidities). Finally, the conversation turns to the idea of “fast progressors,” with Alina and Jörn Schattenberg stating that slow progressors should be the research priority because they are so much more common. Alina suggests that what we call “”fast progressors” might in fact simply be people diagnosed late in the course of disease. As Chris notes, the overall pattern of disease, with its period of dormancy and spontaneous regression, makes this issue a challenge to model. The final comment comes from Roger, who points out that patients during fast progression or rapid decline are the most attractive patient targets economically, since per capita spend will be higher and will continue to increase in later stages of disease. However, he adds, we will need to track patients far more frequently than we do now to confirm or disprove any of these hypotheses about the nature of fast-progressing disease and the proportion of patients who are actual fast progressors.

This conversation is sponsored by Resoundant Resoundant, a Mayo Clinic company and the developers of Magnetic Resonance Elastography. MRE is widely available with over 2000 locations worldwide and can be done as a low-cost, rapid exam in just 5 minutes. Together with PDFF, this quantitative exam is called an Hepatogram – a powerful non-invasive alternative to liver biopsy in many cases. For more information, visit www.resoundant.com on the web.

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