A multistakeholder approach to innovations in NAFLD care

Schattenberg, Jörn M.; Allen, Alina M.; Jarvis, Helen; Zelber‐Sagi, Shira; Cusi, Kenneth; Dillon, John F.; Caussy, Cyrielle; Francque, Sven; Younossi, Zobair M.; Alkhouri, Naim; Lazarus, Jeffrey V.

doi:10.1038/s43856-022-00228-y

Cited by 14 publications

(24 citation statements)

References 26 publications

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“…In the primary care setting, NITs with cut‐offs suggestive of hepatic fibrosis 108,109 could inform general practitioners on the risk for prevalent and incident heart disease in patients with suspected MASLD or heart disease and as a result, initiate preventive actions or refer for a cardiovascular workup in specialty care (Figure 3). 9,110–113 Although the current NITs are better at ruling out than ruling in hepatic fibrosis and their accuracy can be affected by concurrent T2D, 83,114 their determination would allow for the initiation of referral pathways based on age, sex, comorbidities and physical signs and symptoms of heart disease and could therefore be a convenient tool to initiate a personalized diagnostic path 16,35,36,115 …”

Section: Considerationsmentioning

confidence: 99%

Liver stiffness as a cornerstone in heart disease risk assessment

Boeckmans,

Sandrin,

Knackstedt

et al. 2023

Liver International

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Metabolic dysfunction‐associated steatotic liver disease (MASLD) typically presents with hepatic fibrosis in advanced disease, resulting in increased liver stiffness. A subset of patients further develops liver cirrhosis and hepatocellular carcinoma. Cardiovascular disease is a common comorbidity in patients with MASLD and its prevalence is increasing in parallel. Recent evidence suggests that especially liver stiffness, whether or not existing against a background of MASLD, is associated with heart diseases. We conducted a narrative review on the role of liver stiffness in the prediction of highly prevalent heart diseases including heart failure, cardiac arrhythmias (in particular atrial fibrillation), coronary heart disease, and aortic valve sclerosis. Research papers were retrieved from major scientific databases (PubMed, Web of Science) until September 2023 using ‘liver stiffness’ and ‘liver fibrosis’ as keywords along with the latter cardiac conditions. Increased liver stiffness, determined by vibration‐controlled transient elastography or hepatic fibrosis as predicted by biomarker panels, are associated with a variety of cardiovascular diseases, including heart failure, atrial fibrillation, and coronary heart disease. Elevated liver stiffness in patients with metabolic liver disease should lead to considerations of cardiac workup including N‐terminal pro–B‐type natriuretic peptide/B‐type natriuretic peptide determination, electrocardiography, and coronary computed tomography angiography. In addition, patients with MASLD would benefit from heart disease case‐finding strategies in which liver stiffness measurements can play a key role. In conclusion, increased liver stiffness should be a trigger to consider a cardiac workup in metabolically compromised patients.

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Section: Considerationsmentioning

confidence: 99%

Liver stiffness as a cornerstone in heart disease risk assessment

Boeckmans,

Sandrin,

Knackstedt

et al. 2023

Liver International

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“…2,3 However, each metabolic disorder has distinct characteristics, resulting in several subtypes of patients requiring a personalized and multidisciplinary approach. 11…”

Section: Introductionmentioning

confidence: 99%

Tailored Model of Care for Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

El-Kassas,

Awad,

Elbadry

et al. 2024

Semin Liver Dis

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Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is increasing globally, creating a growing public health concern. However, this disease is often not diagnosed, and accurate data on its epidemiology are limited in many geographical regions, making it challenging to provide proper care and implement effective national plans. To combat the increasing disease burden, screening and diagnosis must reach a significant number of high-risk subjects. Addressing MASLD as a healthcare challenge requires a multidisciplinary approach involving prevention, diagnosis, treatment, and care, with collaboration between multiple stakeholders in the healthcare system. This approach must be guided by national and global strategies, to be combined with efficient models of care developed through a bottom-up process. This review article highlights the pillars of the MASLD model of care, including screening, risk stratification, and establishing a clinical care pathway for management, in addition to discussing the impact of nomenclature change on the proposed model of care.

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“…Patients with type 2 diabetes mellitus (T2DM) represent a population with a higher risk of NAFLD compared with the general population, and several studies have demonstrated a bidirectional relationship between these two metabolic conditions. Indeed, the presence of T2DM in patients with NAFLD leads to a higher risk of progression towards NASH, advanced fibrosis and hepatocellular carcinoma as well as a higher risk of cardiovascular complications 1 . Furthermore, cardiovascular disease (CVD) represents the leading cause of mortality in patients affected with NAFLD beyond liver‐related complications 2 …”

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confidence: 99%

“…These important gaps between recommended optimal control of cardiovascular risk using evidence‐based therapies and current management of these patients call for action to close these gaps and require a multistakeholder approach to prevent therapeutic inertia and improve clinical care of patients with T2DM and NAFLD 1 …”

mentioning

confidence: 99%

“…Indeed, the presence of T2DM in patients with NAFLD leads to a higher risk of progression towards NASH, advanced fibrosis and hepatocellular carcinoma as well as a higher risk of cardiovascular complications. 1 Furthermore, cardiovascular disease (CVD) represents the leading cause of mortality in patients affected with NAFLD beyond liverrelated complications. 2 While the field is progressively moving towards a better awareness of NAFLD and NASH with a consensual recognition of the need to better assess the liver status of patients with T2DM, [3][4][5][6] the optimal control of cardiovascular risk factors remains the cornerstone of clinical care of these patients.…”

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confidence: 99%

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