NASH News April 2021
USPSTF Must Include Link to Liver Disease in Recommendation on Screening for Diabetes
Global Liver Institute (GLI) and many of the leaders of the liver, diabetes and obesity advocacy community have submitted a formal letter and comments to the U.S. Preventive Services Task Force (USPSTF) urging the task force to mention the direct connection between diabetes and liver diseases, such as nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), in their recommendations for type 2 diabetes (T2D) and prediabetes screening. The current Draft Recommendation Statement from USPSTF recommends screening adults ages 35 to 70 years who are overweight or obese for prediabetes and T2D but does not mention the strong link between T2D and chronic liver disease.
Signatories on the letter include: GLI, American Association for the Study of Liver Diseases, American Gastroenterological Association, Community Liver Alliance, Digestive Disease National Coalition, Endocrine Society, Fatty Liver Foundation, NASH kNOWledge, Liver Coalition of San Diego, Liver Wellness Foundation and Obesity Action Coalition. View our full press release.
No current recommendations for patients with or at risk of T2D can be considered accurate or evidence-based if they do not include references to NAFLD and NASH. The omission of the clear interconnectedness of diabetes and fatty liver disease in determining and driving risk would be misleading and erroneous and would deprive people living with diabetes of the opportunity for appropriate interventions to reduce their risk for advanced liver disease, need for transplantation, cancer and death.
While we appreciate that USPSTF has shared this draft statement and asked for comments, it doesn’t go far enough. We have respectfully asked USPSTF to update the statement to acknowledge the direct connection between liver diseases such as NAFLD/NASH and diabetes. This additional language will help save lives and enable patients and providers to make more informed decisions.
As part of this year’s International NASH Day, GLI will host a panel discussion on NASH and diabetes and will share a new resource, NAFLD/NASH and Diabetes: What Should Patients Know? Log in to learn more about the connection between NASH and diabetes and how you can help us advocate for improved care and screening. We will keep you updated on the guidance provided by USPSTF.
Donna R. Cryer, JD
President & CEO
Global Liver Institute
GLI Updates
Reaching At-Risk Patients Through COVID-19 Vaccination Sites
GLI has launched a new collaborative effort with Summit Clinical Research to promote NASH awareness in the context of liver health and COVID vaccination via partnerships through city vaccination sites and direct patient education. Providers will be giving people who have just received their COVID-19 vaccination our new resource, After Your COVID-19 Vaccination, Take the Next Step for Your Liver. Please contact NASH@globalliver.org if you would like to share this resource through a COVID-19 vaccination site.
Announcing the 2021 #NASHday Panels
We are pleased to announce the topics for the 2021 International NASH Day panels! Each of the seven panels will feature physicians, community advocates and other experts in NASH from around the world. We encourage patients, caregivers, medical providers, policymakers and all other advocates to log in and learn what actions we can all take to support patients with NASH and reduce the global prevalence of fatty liver disease.
The panels will be streamed through GLI’s Facebook, YouTube and Twitter channels throughout the day on June 10. Registration is not required; just login through the platform of your choice! Check back soon for more information on each panel, including our speakers and the time of each panel.
NASH as a Global Public Health Challenge
NASH and Liver Cancer
NASH and Obesity
Pediatric NASH
NASH and Diabetes
Beyond the Biopsy: Innovations in Diagnostics
NASH in Lean Individuals
U.S. NASH Action Plan: Recommendations for Medical Societies
In our January NASH News, we shared GLI’s U.S. NASH Action Plan, which includes a set of actionable recommendations for the full spectrum of groups involved in NASH prevention and treatment, including: patients and caregivers, clinicians, patient advocacy organizations, medical societies, industry, policymakers, regulators, health systems, and health insurance payers. In each edition of NASH News, we’ll highlight recommendations for each group of NASH stakeholders. This month, we’re highlighting some of the recommendations for medical societies:
Education: Develop and offer NASH-related medical school curricula.
Diagnosis: Convene a consensus conference to drive the acceleration of the adoption of noninvasive diagnostics and the simplification/streamlined version for integration into primary care and diverse (high-low resource) clinical settings.
Patient Management/Treatment: Collaborate with health systems on the development of meaningful quality measures for the diagnosis and management of NAFLD and NASH appropriate to each stage of disease.
Policy Effort/Legislation: Advocate for coverage/reimbursement coding changes and raise awareness of recent NASH coding changes that have occurred (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] and Current Procedural Terminology [CPT]).
NASH Core Curriculum: A Comprehensive Online Resource Center
GLI, in collaboration with Clinical Care Options, has launched NASH Core Curriculum: A Comprehensive Online Resource Center to improve clinician understanding of foundational concepts in NASH diagnosis, management and emerging pharmacologic treatment strategies. Resources will be added throughout the first half of 2021 and are being developed primarily for clinicians, including advanced practice clinicians, in hepatology, gastroenterology, endocrinology and primary care. The full curriculum will include CME/CE-certified video modules, ClinicalThought™ expert commentaries, and downloadable presentations and resources.
The most recent module shared online focuses on NASH risk factors and prognostic indicators and features Manal Abdelmalek, MD, MPH, as the module presenter. NASH Core Curriculum is supported by educational grants from Gilead Sciences and Novo Nordisk.
Upcoming Events
May 6: Full NASH Council Meeting. Contact NASH@globalliver.org for more information.
June 3: NASH Council Policy Working Group. Contact Andrew Scott for more information.
June 10: International NASH Day. To become a partner, submit an application online. Contact Larry Holden for sponsorship information.
September 20-24: Advanced Advocacy Academy. Contact Jen DelGrande for more information.
Patient Perspective
Patient View Shared in AARP Article on NASH and Obesity
In an article shared on AARP.org on March 18, 2021, Cesar Alvarez shares his experience with learning that he had NASH. Read the full article titled Fatty Liver: Another Scary Reason to Lose Weight Today. Excerpt below:
“Cesar Alvarez had never had a drink in his life. So he was surprised when, at age 47, his doctor told him something was wrong with his liver. Alvarez had been taking high levels of painkillers to manage rehab from knee surgery, and at first, doctors attributed his abnormal tests to the meds. But several months later, Alvarez began to feel sick.
"I lost all motivation. Just walking to my car from the house exhausted me,” Alvarez recalls. “And then my skin turned yellow.” His doctor recommended a liver biopsy, which revealed Alvarez had nonalcoholic fatty liver disease, or NAFLD, a once-rare condition first identified in the 1980s.
Alvarez's problem began when, working as a firefighter in Los Angeles, he was seriously injured on the job and bedridden for a year. While immobilized, he rapidly gained 30 pounds. His doctors theorized that his weight gain, possibly exacerbated by painkillers, caused his liver to accumulate the fat that showed up on his biopsy and triggered a swift downward spiral.”
GLI Partner Highlight
diaTribe
GLI is pleased to welcome diaTribe as one of the newest members of the GLI NASH Council. diaTribe, a patient-focused online publication, is part of The diaTribe Foundation’s mission to improve the lives of people with diabetes. diaTribe seeks to empower its readers with useful, actionable information that gives them hope for a better future and helps them live happier and healthier lives.
Hepatic Steatosis, Rather Than Underlying Obesity, Increases the Risk of Infection and Hospitalization for COVID-19
In a new study, British and U.S. researchers examined whether pre-existing hepatic steatosis affects the risk of infection and severity for COVID-19. The study included 502,506 participants (healthy at baseline) in the UK Biobank, of whom 41,791 underwent MRI (aged 50–83) for the assessment of liver fat, liver fibro-inflammatory disease and liver iron. Positive COVID-19 tests were determined from UK testing data, starting in March 2020 and censored in January 2021. UK Biobank data revealed obese individuals with fatty liver disease were at increased risk of infection and hospitalization for COVID-19. Read the research article published on March 29, 2021, in Frontiers in Medicine.
Research & Development
NASH Limits Anti-Tumor Surveillance in Immunotherapy-Treated HCC
Data from a new study shared in Nature collectively show that non-viral hepatocellular carcinoma (HCC), and particularly NASH–HCC, might be less responsive to immunotherapy, probably owing to NASH-related aberrant T cell activation causing tissue damage that leads to impaired immune surveillance. The authors share that the data provide a rationale for the stratification of patients with HCC according to underlying etiology in studies of immunotherapy as a primary or adjuvant treatment. Read the study.
EASL to Hold Digital NAFLD Summit 2021
The European Association for the Study of Liver Disease (EASL) has announced the launch of the Digital NAFLD Summit 2021, taking place September 16-17, 2021. Attendees will learn from the latest research on NAFLD and NASH presented by top international experts. Submit an abstract or register online at the early-bird price.
Clinical Care
High Liver Enzymes Increase Diabetes Risk for Hispanic Adults
Medical scientists at the Albert Einstein College of Medicine located in Bronx, NY, U.S., have analyzed data from 6,928 adults of Hispanic/Latino background who did not have diabetes, did not report excessive alcohol use, and did not have hepatitis B and C infection at baseline (2008–2011). The study found that higher ALT and GGT levels are associated with an increased risk of developing diabetes among Latinos. In addition, liver enzyme tests might aid in diabetes prevention by identifying high‐risk individuals. View the research article published on January 12, 2021, in Diabetic Medicine and read more in LabMedica.
High-Sugar Diets Put Kids at Increased Risk for Liver Disease, Experts Say
A review of more than 20 studies conducted by researchers at the Translational Genomics Research Institute and Arizona State University found that the prevalence of NAFLD in children worldwide is growing and that high-sugar diets are part of the problem. “We hope to develop better tools to help clinicians decide which kids need a sophisticated work-up and which ones don't," said Gabriel Shaibi, an Arizona State researcher. Read more in Philly Voice and view the research article published on December 11, 2020, in Pediatric Obesity.
Current Clinical Trials
Fatty liver disease (FLD) and non-alcoholic steatohepatitis (NASH) are increasing in prevalence worldwide, creating a major global public health crisis. To adequately educate patients, practitioners and policy makers, there is a need to collect, curate and share relevant information. NASH News, published on behalf of the Global Liver Institute’s NASH Council, intends to meet that need and to facilitate collaboration across the emerging NASH community on a monthly basis.
We would appreciate your feedback and content contributions. Please contact nash@globalliver.org