In yet another topical debut, Surfing NASH explores pediatric and adolescent Fatty Liver disease, its alarming prevalence and developing the field’s understanding around how to treat this vulnerable subpopulation. The Surfers are joined in discussion by Naim Alkhouri and chief of Gastroenterology, Hepatology and Nutrition at Children’s Hospital Los Angeles, Rohit Kohli.
This is a special session which illuminates a critical issue intimate to two extremely knowledgeable guests. Rich with invaluable insights, the panelists elaborate on the following major themes:
08:55
Roger Green prefaces this conversation with the observation that as a pandemic of Fatty Liver disease grows at boggling speed, so too does NAFLD and NASH in younger populations. While this recognition may in part be attributed to improved methodologies, it is evident that lifestyle norms around diet and exercise continue to exacerbate the problem. Rohit expands on this notion by sharing apt research examples which demonstrate swelling prevalence in younger populations. He suggests that while methodologies have improved, we are indeed witnessing increasing incidence. Most strikingly, Naim refers to an anecdote witnessed in his clinic of a 13 year-old patient with biopsy-proven cirrhosis.
16:05
Jörn Schattenberg steers discussion toward the cardiometabolic implications behind patients living longer with Fatty Livers. Naim describes a paper he co-authored which sought to strengthen understanding of epidemiology by histopathology reports in Sweden. With access to virtually all liver biopsies in the country, the group set out to identify cardiovascular disease emerging in patients previously diagnosed with NASH under the age of 25. He details results which underscore a swathe of associations linking Fatty Liver to metabolic complications. Rohit adds comments around the role and appropriateness of bariatric surgery in adolescents to mitigate the long-term metabolic consequences of obesity. Louise Campbell prompts explanations around histopathological differences in adolescents versus adults, and what’s unique in the application of NITs for younger patients.
28:37
The group continues to consider how to accelerate clinical trial learnings into real world implementations. This develops into ideas around effectively introducing lifestyle interventions to children at a societal scale. It’s noted and agreed that nutritional matters are family matters. Rohit describes guidelines which utilize annual physicals with adolescents as an opportunity to track liver health. Naim goes on to describe elements contributing to our understanding of early life risk and natural history of disease.
38:22
As the session winds down, Roger asks the panelists for what impact they envision emerging trials and drugs to have in the pediatric space. Each provides thought-provoking responses and Louise raises grave concern over coping with the enormous industry influence on the milieu of nutrition surrounding children. Listen to the full feature to hear the various reactions.
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