Recommendations to enable and optimize a multidisciplinary approach in #NAFLD care. #livertwitter @AlinaAllenMD @AlkhouriNaim @JVLazarus nature.com/articles/s4385…
Evaluate benefit and cost-effectiveness of multidisciplinary models of care based on NITs, which should be adopted by first-line providers, such as PCPs and endocrinologists, and monitor their use. nature.com/articles/s4385…
Implement context-specific (prevention, screening, risk-stratification, treatment) and resource-specific (for low-, middle- and high-income settings) models of care and always report their effectiveness.
Develop, provide and monitor guidance, endorsed by professional societies, regarding preventive hepatology and specific criteria for referral to specialty care such as hepatology, cardiology, endocrinology, obesity specialists, bariatric surgeons and exercise physiologists.
Delivery models must overcome the time-constraints by decreasing the human burden (automated screening and risk-stratification, multidisciplinary clinics, virtual care, nurse coordinators, web-based applications for longitudinal care, virtual assistants).
Generate evidence to provide policy-makers the basis to recognize #NAFLD as a significant public health threat and allocate the appropriate resources to address it. pubmed.ncbi.nlm.nih.gov/36596859/
The World Health Organization should integrate all types of steatotic liver disease into non-communicable disease technical guidance, action plans and strategies, setting out how to best implement a multidisciplinary approach. nature.com/articles/s4385…

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More from @scottisaacsmd

Dec 11, 2022
Bart Staels, PhD of Univ of Lille, France gave an outstanding talk on Interplay Between #NAFLD & #CVD at the #WCIRDC. CVD is the leading cause of death not liver disease. Fibrosis severity correlates with higher CVD risk. @WCIRDC @YHandelsmanMD
healio.com/news/endocrino…
Type 2 #diabetes and #NAFLD have a reciprocally injurious relationship mediated through common pathophysiology magnifying the risk for #CVD events.
pubmed.ncbi.nlm.nih.gov/33015726/ @zilbermint @AlinaAllenMD
#NAFLD is considered the hepatic manifestation of the metabolic syndrome and is closely linked to:
#Obesity, especially visceral adiposity
✅Insulin resistance
✅Chronic inflammation
#Lipotoxicity
nature.com/articles/s4141…
Read 9 tweets
Sep 19, 2022
Thyroid hormones regulate liver enzymes via thyroid hormone receptors. When the liver is steatotic, hepatic thyroid hormone receptors don’t respond effectively. This results in an intrahepatic hormonal milieu where the liver is essentially hypothyroid. #livertwitter #endotwitter
Thyroid hormone receptor-β plays a key role in hepatic homeostasis including:
✅De novo lipogenesis
✅Fatty acid β-oxidation
✅Mitophagy
✅Mitochondrial biogenesis
✅Cholesterol metabolism
✅Carbohydrate metabolism
#livertwitter #endotwitter
Thyroid hormone receptor-β agonism has demonstrated clinical benefits on hepatic lipid metabolism.
frontiersin.org/articles/10.33…
Read 12 tweets
Sep 4, 2022
Thyroid hormones regulate liver enzymes. When the liver is fatty, thyroid hormones don’t work right. #HepaticHypothyroidism
Hepatic enzymes responsive to #thyroid hormones will slow down when the liver is fatty. Thyroid hormone has a dominant effect on HMG-CoA reductase in the liver which regulates cholesterol levels which is why #hypothyroidism causes high cholesterol. #HepaticHypothyroidism
Thyroid hormone regulates fatty acid β-oxidation in the liver. This is a process that breaks down fat for energy. #NAFLD impedes the process in a viscous cycle where liver fat continues to build up, energy levels plummet, unresponsive to thyroid hormone. #HepaticHypothyroidism
Read 10 tweets

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