Arizona Liver Health Institute V.P. of Academic Affairs and Fatty Liver Program Director Naim Alkhouri and Global Liver Institute Founder and CEO Donna Cryer join Louise Campbell and Roger Green to discuss their recent projects and accomplishments. Each of them brings newsworthy stories that lead to thoughtful, stimulating conversations about a range of issues.
Naim Alkhouri’s news includes two recent academic publications and some exciting, innovative new projects. One of his publications, the EDICT trial, contrasted two sets of T2D patients that were treated with different regimens. One set was treated with a “classic” regimen of metformin, a sulfonylurea and insulin — agents that are liver-neutral or problematic. The other set was treated with a more friendly regimen of pioglitazone, a GLP-1 and metformin. Not surprisingly, when patients in the two groups were evaluated, the differences were dramatic. The other paper was a collaboration with the Pfizer NASH team, looking at 10,000 NHANES patients who were evaluated using FibroScan to estimate the proportions of NAFLD and NASH in the population. The numbers here were consistent with public health estimates. One interesting point: the CAP threshold the researchers used in this paper was far different from what Louise uses when evaluating patients with Tawazun Health. The difference? Louise chooses lower levels in the belief that lower levels will motivate more patients towards self-care, while Naim’s higher levels reflect the score at which physicians are likely to prescribe medications. This led to a conversation on the value of this two-metric approach: one level for self-care and a higher one for medication. As Roger notes, this aligns with the concept of “prehypertension” that has him taking steps to reduce his blood pressure slightly without the aid of medication. Naim goes on to discuss two novel sets of studies he is conducting, one with the diet app Noom and the other with a range of digital therapeutics companies.
Donna Cryer begins by announcing she has three pieces of news to report: a recently released paper supported by Novo Nordisk and developed with a group convened by the National Committee for Quality Assurance, titled “A Rallying Cry: Improving Coordinated Care for People with Nonalcoholic Steatohepatitis,” a scientific statement from the American Heart Association on the connection between NASH and cardiovascular disease, and the formal launch of GLI’s “Liver Health is Public Health” campaign. The NCQA paper and entire idea of liver health as public health launch spirited conversation with emphatic agreement among the three participants. When Roger shares some thoughts from Naim’s conversation about the potential for digital heath apps to become personalized and tailored over time, it leads Donna to a fourth announcement about a talk she is giving next week at the University of California Health System on the use of data for the public good. As with Naim, the conversation turns to the use of digital health in its many forms to improve liver care.
Combined with the Episode 20 conversation with the three permanent Surfers, this episode connects the many streams of Fatty Liver research into a single package that is part pharmacotherapy, part better diagnostics, part digital health and part public policy.