NAFLD is a spectrum that includes NASH. First rule out secondary causes.
Difference between NAFL and NASH? NAFL is just the accumulation of fat w/o ballooning or much inflamation. NASH has hepatocyte changes from ballooning and inflammation. IIt is staged also based on fibrosis (F0-F4)
Natural history25-37% of #NAFLD is #NASH. Fibrosis progression usually 1 stage every 7yrs. Fibrosis can be slow or rapid and there are many pathogenic drivers of NAFLD and it's progression #AACE2022#endotwitter
NAFLD -- adipose overload leading to steatosis leading to inflammation leading to fibrosis and cirrhosis
Prevalence is high (US prevalence 38% for #NAFLD, 37% of which have NASH) and substantially underdiagnosed. DM2 + BMI >35 90% have steatosis!
Mortality is increased for the entire spectrum of NAFLD. Stage 2 Fibrosis Is the Tipping Point for
Liver Related Mortality
Identify the high risk groups (PreDM, DM, Obesity, increase CV factors, LAE elevation) and evaluate for #NAFLD. We need to increase screening #endotwitter#AACE2022
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Let's hear The Evidence For and Against Combination #Thyroid Hormone therapy by Dr. Bianco #AACE2022#Endotwitter. This conversation is controversial here are some of the main slides
Patient's on Lt4 reporting a lot of residual symptoms in energy, cognition
Normal physiology the majority of thyroid hormone production is T4 (16:1 T4:T3) and gets converted peripherally to T3 (5mcg made in thyroid, 25mcg made peripherally)
Now to talk about Phosphatonins and #phosphorus metabolism/bone disease by Dr. Kumar moderated by @sfeirjad...I'm ready to learn since admittedly I know little of this #AACE2022#Endotwitter#bone
Why bother about phosphorus? Well it plays many roles in cellular signaling and maintenance of membrane structure of #bone. Low concentrations associated with rhabdo, decreased cardiac function and bone dysfunction (#osteomalacia, #rickets). low and high phos causes bone disease
High Phos Concentrations are Associated with CV Disease and Excess Mortality in CRF and decreasing levels reduces CV mortality
Look how far we have come in #diabetes technology and there is still a lot more to go #AACE2022. #CGM technology has been a game changer and the accuracy continues to improve with each generation
So what's new in the pipeline for #diabetes technology? Let me tell you starting with #dexcom G7. It will be smaller with a better MARD, better warm up and ALL-IN-ONE applicator and transmitter! Just pending FDA review #AACE2022#endotwitter#medtwitter
#NAFLD has effects on other conditions including DM, CVD, CKD etc due to increased hyperinsulinemia, insulin resistance, proinflammatory factors etc
How do we screen for #NAFLD and find the ones with fibrosis? A lot will be missed if just checking transaminases. FIB-4 and NFS is a better screening tool