Thread by @NadiaJamilMD

Session 2 of #AACECVMET that I'm attending is "Nonalcoholic Fatty Liver Disease: The Global Pandemic" by Dr. Scott Isaacs, MD (@EmoryMedicine)! #WeAreAACE

@EmoryMedicine Pathogenic drivers of NAFLD: genetics, epigenetics, dysbiosis, dysfunctional adipose tissue, insulin resistance, and calorie excess #AACECVMET

@EmoryMedicine All stages of NAFLD show increased mortality over a 30yr period, with mortality increasing with fibrosis stage #AACECVMET #NAFLD

@EmoryMedicine NAFLD is underrecognized in the primary care setting: 39% abnormal ALT documents, 21% NAFLD mentioned as a diagnosis, 15% counseled on diet and exercise, 10% referral to a specialist, and 3% high-risk patients referred to specialists. #AACECVMET #EndoTwitter #MedTwitter #AACE

@EmoryMedicine Evaluate fibrosis with the FIB-4 Index, which includes age, AST, ALT, and platelets in the calculation! Low-risk for fibrosis is <1.3 and high risk is >2.67, with indeterminate in-between. The FIB-4 predicts liver disease as well as CV Risk! #AACECVMET #WeAreAACE #GITwitter

@EmoryMedicine The ELF (Enhanced Liver Fibrosis) was FDA-approved in 2021 for prognostic risk assessment in pts w/ NASH at risk for advanced fibrosis. It's associated with: Clinical outcomes & Disease progression. AACE recommends it for diagnostic use in indeterminate scores #AACECVMET #AACE

@EmoryMedicine Pioglitazone has shown significant improvements in NASH in T2DM & prediabetes, incl resolution of NASH in ~30-40% & prevention of fibrosis progression. Risks incl weight gain (dose dep), edema (more w/ insulin or amlodipine), risk of bone loss, & do not use in CHF. #AACECVMET

@EmoryMedicine There is data showing resolution of steatohepatitis & no worsening in liver fibrosis with GLP1s. Tirzepatide (10mg and 15mg) showed improvement in liver fat content as compared to those taking insulin. SGLT2i showed improvement in steatosis and mean ALT. #AACECVMET #EndoTwitter

@EmoryMedicine Great talk by Dr. Issacs! Key points: NAFLD pandemic is here! #Endotwitter & primary care are ground zero. Start w/FIB-4 & use sequential NITs to clarify indeterminate scores. Treatment focused on prevention of cirrhosis and management of cardiometabolic disease. #AACECVMET #AACE