S4-6 – Introduction to NAFLD and NASH in Australia

S4-6 - Introduction to NAFLD and NASH in Australia
The podcast heads Down Under as Louise Campbell hosts this week’s surf from Australia. Joining her is Brisbane-based Director of Gastroenterology & Hepatology at The Prince Charles Hospital, Tony Rahman. The two discuss NAFLD and NASH prevalence, providing for rural populations, FibroScan, FIB-4 and the future of combating Fatty Liver in Australia.

This week on the podcast, Louise Campbell leads the Surf in a one-on-one interview with Tony Rahman on what’s happening for Fatty Liver in Australia. Tony is the Director of Gastroenterology & Hepatology at The Prince Charles Hospital in Brisbane and Adjunct Professor in the College of Medicine and Dentistry at James Cook University. The episode begins with an introduction to Tony’s career, outlining a journey of how he became involved in fighting Fatty Liver disease.

Louise leads by investigating the uncertainties around prevalence of NAFLD and NASH in Australia. Not only is it unclear exactly how many people have Fatty Liver there, but also who comprises this total population. Specifically, she wonders what percent of this group are Aboriginal peoples. While his personal experience at one hospital does not lend perspective to this question, Tony points to an ongoing project on diabetes with James Cook University. A considerable cohort of First Nations patients were recruited and it was determined that instances of Fatty Liver disease in this group were “moderately high.” In terms of the whole of Australia, Tony underscores insights from the Australian Institute of Health and Welfare which reports an alarming rise in prevalence. It is estimated that the country will increase from 20-25% of a population with NAFLD to as high as 40% by 2030. Tony casts doubt on the accuracy of the current numbers, suggesting that prevalence is likely to be much higher already due to rates of obesity. He adds that with a broadened definition from NAFLD to MAFLD, the inclusion of those who are not overweight but possess other metabolic risk factors will only surge figures higher yet.

Focus next shifts to a program Tony contributes to called Heart of Australia, the country’s first mobile medical program delivering specialist services to regional and remote communities. He explains the inception of the initiative and how he helped to introduce FibroScan as a part of its services. Around 7 million people – 28% of Australia’s population – live in rural or remote areas. Louise comments on the importance of delivering health care solutions to these populations and expanding accessibility and promoting education. She draws comparison to her own experiences working remotely in Australia to provide virtual clinics to those living 6 to 10 hours drive away from their nearest consultation. When asked whether GPs want to buy into NAFLD and NASH in the same way that they responded to Hepatitis C programs, Tony says yes. He notes the influence of how a problem and solution are presented has on the uptake of interest and whether the benefits posed are considered worthwhile. GPs in Australia are paid per patient and time away for education can be a loss of income. He suggests that rather than solely “bombarding GPs with education,” change will more readily be adopted if there is a robust plan in place. He goes on to explain a traffic light system adopted by the Prince Charles Hospital that utilizes FibroScan to assess the likelihood of a patient to develop liver disease in coming years. The main takeaway: establishing a good model requires refinement.

As the session winds down, they continue on to explore the role of FIB-4 in Australia and the link between Fatty Liver disease and cardiovascular outcomes. This leads to ideas around private versus public sector health care dynamics and creating equitable access to FibroScans. Lastly, Louise and Tony consider the prospect of a drug approval and whether Australia is prepared to identify the patients most in need.

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