Kavita Garg, United States of America
Moderator of 1 Session
Presenter of 2 Presentations
NAFLD/NASH and diabetes
Introduction and emerging imaging technologies for NAFLD/NASH
Abstract
Background and Aims
Non-alcoholic fatty liver disease (NAFLD) is becoming an important public health concern globally. It is associated with cardiovascular disease, type 2 diabetes, and cancers. In the US, it is the third leading cause of cirrhosis and second most common indication for liver transplant (first in women). Global prevalence of NAFLD is about 25% with a significant recent increase in emerging economies, and in the Middle East the presence of NAFLD may be as high as 70% in patients with type 2 diabetes. Unfortunately, a significant number of patients with NAFLD go on to develop non-alcoholic steatohepatitis (NASH) which is much more common in patients with type 2 diabetes. About 20% of the US population have NAFLD without associated diabetes. However, 33-66% of patients with type 2 diabetes have NAFLD. Other risk factors associated with NAFLD include obesity, age, gender, dyslipidemia, metabolic syndrome, and polycystic ovarian syndrome.
Methods
There are many ways to image NAFLD and NASH, including abdominal ultrasound, CT scan, and MRI or MR spectroscopy. More recently, elastography performed with ultrasound or MR has gained traction in diagnosing different stages of NAFLD and NASH. In this chapter, we plan to review some of the challenges in increasing global prevalence and early diagnostic methods to evaluate NAFLD.
Results
Unfortunately, NAFLD and NASH is increasing in prevalence globally and is becoming the leading cause of end-stage liver failure. Newer imaging methods are becoming more popular in screening and managing patients with NAFLD and NASH. A significant number of patients with NASH will go on to develop cirrhosis, which may result in hepatocellular carcinoma. Thus, early detection and management of NAFLD is critical. Percutaneous liver biopsy is no longer considered the gold standard for diagnosing NAFLD/NASH because of the small sample size, sampling error and complications related to the invasive nature of the procedure. Newer imaging technologies like MR elastography and other associated biochemical markers are noninvasive and reasonably accurate in diagnosing NAFLD.
Conclusions
Studies have shown that in people with extremely high BMI, bariatric surgery helps not only with type 2 diabetes but also in advanced stages of NASH, with a significant reversal of liver function test. Many type 2 diabetes medications like GLP analogs, SGLT2 inhibitors, alone or in combination, have been shown to significantly reduce the liver fat and further progression of NAFLD and NASH. Many attempts are being made to look at other targets like anti-CD3 and dual GLP-GIP agonists are being evaluated for treatment of early stages of NAFLD.