Liver disease isn’t talked about as much as heart disease, diabetes, and other common chronic illnesses. But “silent” conditions like nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) commonly affect those with type 2 diabetes and obesity, causing a rising burden in the U.S. and around the world.
Kim Pfotenhauer, DO, BC-ADM, Director of Clerkship Curriculum at MSU College of Osteopathic Medicine, is among the authors of a newly-published paper entitled “Preparing for the NASH Epidemic: A Call to Action.”
Published in Gastroenterology, Diabetes Care, Metabolism: Clinical and Experimental, and Obesity: The Journal of the Obesity Society, the paper is the first product of an international conference where 32 experts came together to develop a multidisciplinary action plan to implement better screening, diagnosis, and treatment plans for NAFLD and NASH. Pfotenhauer, a fellowship-trained diabetologist, was invited to participate in the conference to provide her perspective as a primary care physician.
Because NAFLD and NASH are on a spectrum of disease, there’s real potential to make a difference by taking a more proactive approach to these conditions. If left untreated, NAFLD can progress to NASH. NASH is similar to cirrhosis, and once liver disease has progressed to this point, it’s unchangeable and there’s a higher risk of liver cancer and other liver diseases. NASH is quickly becoming one of the top reasons for liver transplant in the U.S.
The links between NAFLD, NASH, and other diseases are also becoming clearer. Patients with NAFLD and NASH are at a higher risk for cardiometabolic problems and cardiovascular disease, Pfotenhauer explained. What’s more, because people with type 2 diabetes and obesity are at higher risk of developing NAFLD and NASH, it’s especially important for them to be screened on a regular basis. But until now, there hasn’t been a standardized screening process.
In fact, NAFLD and NASH are often considered incidental findings, or conditions discovered during testing for other conditions. Doctors may not be sure what the next step is when a patient is diagnosed, particularly because it was once thought that these conditions weren’t necessarily risky.
This is why Pfotenhauer and her colleagues created screening guidelines to help primary care physicians detect and potentially prevent NAFLD and NASH. “More people have this than we know, and more people have this than they know,” she explained. “It's very prevalent, undertreated, and under-recognized. Until we screen for it, we don’t know it’s there. And until we know it’s there, we won’t know how many people are affected, and how much our treatments can help.”
“The beauty of the proposed screening process is that it utilizes lab results doctors likely already have for their patients,” Pfotenhauer said. Doctors will be able to plug values into a risk calculator, and receive a low, intermediate, or high risk result. From there, they can decide whether patients need further care.
The guidelines propose that primary care physicians be the first line in screening and treatment. “Lifestyle changes and weight loss are the mainstays of treatment for these conditions right now, with only some patients needing specialist care or medications” Pfotenhauer said.
At the same time, this project highlighted how crucial it is for physicians to collaborate—from primary care to specialty care, Pfotenhauer noted. “It's not just one specialty or type of physician who is going to take on the burden of this. We have to work together to get patients excellent care.”
After this initial paper, forthcoming publications from the same group of physicians will include more specifics on proposed guidelines for the clinical care screening pipeline pathway, diagnosis, and treatment, and how doctors can begin to use them to work towards better patient outcomes.