Gabriella Wan

  • published Nutrition 2021-03-25 11:05:18 -0600

  • published Velacur in noninvasive tests 2021-03-08 08:13:05 -0700

    Velacur

    Velacur

    What it measures: fibrosis, steatosis
    Who should take it: undiagnosed and diagnosed NAFLD/NASH patients
    Where to get it: certain primary care providers, specialty centers, and hospitals; clinical trials
     

    Velacur is an imaging-based diagnostic test developed by SonicIncytes that looks at liver fibrosis (stiffness, scarring) and steatosis (fat) using ultrasound technology. Velacur can be used to help diagnose and monitor NAFLD/NASH and is a quick and comfortable procedure. Velacur uses technology similar to MRI elastography, using multiple frequency steady-state waves to generate a 3D liver tissue sampling.[1] The images produced are enhanced by machine-learning and multiple clinical studies have demonstrated consistently high correlation to MRI for measuring steatosis and fibrosis.[2]

    Your physician or a trained technician perform the procedure on you while you are lying down, placing a gently vibrating pad under the right side of your back and running an ultrasound probe over your ribs to scan your liver. The entire process takes only about 5 minutes and results are immediately available.[3]

    Results from a Velacur reading can be seen in the image below. The two main results from the scan are elasticity and attenuation. Elasticity is a measure of fibrosis and attenuation is a measure of steatosis. Together, these scores will allow your provider to diagnose and monitor the severity of your NAFLD/NASH.

    In comparison to transient or ultrasound elastography, Velacur’s advantages are deeper tissue measurement, larger tissue sampling, 3D data acquisition, using a single probe for all body types, fewer user readings required, machine-learning enhanced image guidance, and greater comfort.[4] In comparison to other diagnostic tools, Vealcur is the most cost-effective and has the advantage of not requiring pre-approval from insurance.[5]

     

     

     

    [1] SonicIncytes, Products, https://www.sonicincytes.com/products/

    [2] SonicIncytes, Products, https://www.sonicincytes.com/products/

    [3] SonicIncytes, Patient Brochure, https://sonicincytes.com/wp-content/uploads/2020/12/SI_VelacurBrochure_WEB.pdf

    [4] SonicIncytes, Technology, https://www.sonicincytes.com/technology/

    [5] SonicIncytes, Products, https://www.sonicincytes.com/products/


  • published CBD in RESOURCES 2021-02-24 10:53:13 -0700

    CBD and Liver Disease

    By Gabriella Wan

    CBD, or cannabidiol, is a non-psychoactive component of the cannabis plant with anti-inflammatory properties.[1]  To ensure avoidance of psychoactive effects, CBD must be extracted from hemp, not traditional marijuana.[2] In recent years, CBD has become a popular supplement. CBD works in the body through the endocannabinoid system, which is highly upregulated during chronic liver disease, affecting multiple steps along the disease’s progression.[3]

    Some research has been done concerning the interactions between CBD and liver disease, with mixed but promising results. The first thing to understand about CBD is that there are two important related receptors in our bodies, called CB1 and CB2. As noted in a 2008 study, cannabinoid receptors (CB1 and CB2) and their binding molecules (endocannabinoids) have emerged as novel mediators of liver diseases. While activation of CB1 receptors can contribute to NAFLD and fibrosis, activation of CB2 receptors have been characterized as antifibrogenic and regulators of inflammation.[4] With this understanding, it makes sense that inhibiting CB1 receptors has been shown to inhibit the progression of fibrosis, while activating CB2 receptors has been shown to inhibit growth and cause cell death for cultured liver fibrogenic cells. Because CB1 and CB2 receptors exert opposite effects on liver fibrosis, evaluating the net impact of using endocannabinoid signaling on liver fibrosis in a clinical setting is complicated and far from clear cut.[5]

     

    “EC receptors expression and functions in the liver. Cannabinoid receptors CB1 and CB2 are expressed in all liver cell types at different basal levels. Both receptors are upregulated during chronic liver damage and mediate opposite functions: CB1 promotes and CB2 protects from liver damage. The experimental and clinical evidences indicate CB1 as a stronger player, contributor and an attractive target in the development of CLD. Abbreviations: ALD, alcoholic liver disease; HCC, hepatocellular carcinoma; NASH, nonalcoholic steatohepatitis; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis; TG, triglyceride; VLDL, very low density lipoprotein.”[6]

     

    In animal tests, the relationship between CB1 receptors and fatty liver (both diet-induced and obesity-associated) has been made clear. Research has shown that high-fat diets induce fatty liver via activation of CB1 receptors, which are necessary for the development of diet-induced steatosis, dyslipidemia, and insulin resistance.[7] Studies with obese rats have shown that the administration of CB1 inhibitors reduced obesity-associated hepatic steatosis and certain features of metabolic syndrome.[8] The drug Rimonabant was the first selective CB1 inhibitor used in clinical practice after clinical trials showed its benefit on weight reduction, abdominal obesity, liver steatosis, and other cardiometabolic syndromes.[9] Though this may seem like good news, it is important to note the increased appearance of psychiatric disorders including depression, anxiety, irritability, and aggression.[10] Consequently, the FDA never approved Rimonabant for the treatment of obesity.

    While we have lots of research on CB1 receptors and fatty liver, investigations regarding the role of CB2 receptors in this disease area are minimal. In human studies, liver samples from patients with steatosis and steatohepatitis have expressed CB2 receptors, while liver samples from normal livers showed no CB2 receptor expression.[11] In fibrogenesis, CB2 activation has exhibited some evidence of an anti-fibrogenic role.[12] In rats, studies have shown that activating CB2 receptors in the liver significantly reduced collagen content in rats with pre-existing cirrhosis and improved regenerative response to acute liver injury.[13] It is important to note that other studies have shown conflicting results regarding CB2 and NAFLD.[14]

    While you should always consult with your doctor before starting to use any supplement, CBD has some special considerations. If you decide to take it even though the jury is still out on the effects of CB1 and CBD on NAFLD, please be cautious of the following things:

    • Dosage
      • The amount of CBD recommended for therapeutic use in humans ranges from 0.5mg/kg/day to 20mg/kg/day.[15]
      • FDA hasn’t created any measures to regulate CBD products, so potency labels can be inaccurate.
    • Quality
      • FDA hasn’t created any measures to regulate CBD products, so they may be contaminated or misrepresented.
      • To find safe and reputable products, make sure the company has third-party lab testing, good reviews, and transparency for its products (including sourcing, extraction methods, packaging, and return policies).
    • Interactions with other medications being processed by CYP450 family of liver enzymes
      • Many conventional doctors do not know much about CBD since it’s not taught in medical school, so it may be best to ask them if any of the drugs you’re taking are affected by eating grapefruits, since grapefruit also affects the same liver functionality.[16]

    Gabriella Wan is a Program Coordinator at the Fatty Liver Foundation with a background in public health. She is passionate about improving quality of life through lifestyle change, awareness raising, and education.

     

    Sources

    [1] Avraham, Y, et al, Cannabidiol improves brain and liver function in a fulminant hepatic failure-induced model of hepatic encephalopathy in mice, British Journal of Pharmacology, April 2011, doi: 10.1111/j.1476-5381.2010.01179.x

    [2] Tesséra Naturals, Does CBD cause liver damage?, CBD Education, August 2020, https://tesseranaturals.com/does-cbd-cause-liver-damage/

    [3] Mallat, A and Lotersztajn, S, Endocannabinoids and liver disease. I. Endocannabinoids and their receptors in the liver, American Journal of Gastrointestinal Liver Physiology, January 2008, doi: 10.1152/ajpgi.00467.2007

    [4] Mallat, A and Lotersztajn, S.

    [5] Mallat, A and Lotersztajn, S.

    [6] Patsenker, E and Stickel, F, Cannabinoids in liver diseases, Clinical Liver Disease, February 2016, doi: 10.1002/cld.527

    [7] Osei-Hyiaman, D, et al, Hepatic CB1 receptor is required for development of diet-induced steatosis, dyslipidemia, and insulin and leptin resistance in mice, Journal of Clinical Investigation, September 2008, doi: 10.1172/JCI34827

    [8] Gary-Bobo, M, et al, Rimonabant reduces obesity-associated hepatic steatosis and features of metabolic syndrome in obese Zucker fa/fa rats, Hepatology, July 2007, doi: 10.1002/hep.21641

    [9] Christopoulou, FD and Kiortsis DN, An overview of the metabolic effects of rimonabant in randomized controlled trials: Potential for other cannabinoid 1 receptor blockers in obesity, Journal of Clinical Pharmacy and Therapeutics, February 2011, doi: 10.1111/j.1365-2710.2010.01164.x

    [10] Christopoulou, FD and Kiortsis DN

    [11] Mendez-Sanchez, N, et al, Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease, Liver International, March 2007, doi: 10.1111/j.1478-3231.2006.01401.x

    [12] Julien, B, et al, Antifibrogenic role of the cannabinoid receptor CB2 in the liver, Gastroenterology, March 2005, doi: 10.1053/j.gastro.2004.12.050

    [13] Muñoz-Luque, J, et al, Regression of fibrosis after chronic stimulation of cannabinoid CB2 receptor in cirrhotic rats, Journal of Pharmacology and Experimental Therapeutics, November 2007, doi: 10.1124/jpet.107.131896

    [14] Dibba, P, et al, Mechanistic Potential and Therapeutic Implications of Cannabinoids in Non Alchoholic Fatty Liver Disease, Medicines, May 2018, doi: 10.3390/medicines5020047

    [15] Curley, Christopher, Worried About CBD Hurting Your Liver? Here’s What the Experts Have to Say, healthline.com Health News, August 2019, https://www.healthline.com/health-news/can-cbd-hurt-your-liver-what-to-know-about-a-new-study?c=672391731507

    [16] Tesséra Naturals.


  • published Healio Features in RESOURCES 2021-02-16 14:10:43 -0700

    Healio Features

     Image result for fatty liver foundatoin logo     +     Image result for healio logo

     

    The physician resource Healio.com has interviewed FLF CEO and Co-Founder Wayne Eskridge twice. We hope that sharing Wayne's experience as a patient with the physician community may help in changing the landscape towards more patient-centered care. If you are interested in watching the short interviews, they can be found at the links below.

     

    The first interview was conducted at the International Liver Congress in Vienna, Austria in 2019. In this video, Wayne discusses the need for physicians to support patients who are engaged in their health care. To watch click here

     

    The second interview was conducted over Zoom in 2021. In this video, Wayne speaks about FLF's recent efforts to help blunt the epidemic of liver disease and how the Foundation's goals for this year have been shaped by the COVID-19 pandemic. To watch click here.


  • published FibroScan in noninvasive tests 2021-02-11 12:22:43 -0700

    FibroScan

    FibroScan

    What it measures: fibrosis, steatosis
    Who should take it: undiagnosed and diagnosed NAFLD/NASH patients
    Where to get it: specialty care centers, hospitals, some primary care providers

    FibroScan is an imaging-based diagnostic test developed by Echosens that looks at liver fibrosis (stiffness, scarring) and steatosis (fat) using transient-elastography technology. FibroScan can be used on patients in need of staging of their NAFLD/NASH, whether their condition is suspected or biopsy-confirmed. FibroScan works similarly to an ultrasound, emitting a small pulse of energy, called a shear wave. The speed of the shear wave is measured as it travels through your liver, generating two scores to determine overall liver health. The first score measures liver stiffness and the second score measures liver fat. In combination, these scores can help you understand your overall liver health and how it may change over time with lifestyle or medical interventions.[1] The only thing you will feel while taking the test is a light vibration on your skin and the entire procedure takes less than 10 minutes.

    Depending on where you get a FibroScan may determine the scoring system used in your diagnosis. Typically, a 5-pointscoring system is used to grade the degree of liver fibrosis, from F0-F4. Scores from the FibroScan will be in kilopascals (kPa), ranging from 2 to 75 kPa. Normal livers fall between 2 and 6 kPa, with anything outside this range indicating some degree of liver disease.[2] The table below, adopted from MSK, considers different scores in the context of different liver diseases and can be used to help determine fibrosis score. It is important to remember that the ranges in the table are estimates, and your actual fibrosis score may not match what the table says. When determining your actual fibrosis score, in addition to your fibrosis measurement, your provider will take into consideration your health history and the grade of steatosis.

    To use the table, find the liver disease that you have on the left side of the table. Read across the row from left to right until you find the range that includes your fibrosis result. Then, look at the top of that column to see the fibrosis score.[3]

    FibroScan has been in available in the European market since 2003 and was expanded to China, Canada, Brazil, Japan, and many other countries before being approved by the FDA in 2013.[4] It is reimbursable by insurance. To find a location near you with a FibroScan machine, use Echosens’ locator, which can be found here.

     

     

     

    [1] Echosens, For Patients, https://echosens.us/for-patients/

    [2] Memorial Sloan Kettering Cancer Center, Understanding Your FibroScan Results, February 2018, https://www.mskcc.org/cancer-care/patient-education/understanding-your-fibroscan-results

    [3] Memorial Sloan Kettering Cancer Center

    [4] Echosens, FDA Approves FibroScan® for Non-invasive Liver Diagnosis, April 2013, https://www.prnewswire.com/news-releases/fda-approves-fibroscan-for-non-invasive-liver-diagnosis-203186961.html#:~:text=%2D%20Echosens%E2%84%A2%20is%20pleased%20to,technology%20in%20the%20United%20States.

     


  • Got NASH? Johns Hopkins needs your help

    We are partnering with Johns Hopkins on a COVID-19 project vital to patients with NAFLD/NASH. As you know, we have been critical of the vaccine developers and the CDC for not engaging patients with liver disease. We want to know what to expect from this vaccine and the only way to find out is to do the testing.

    We are pleased to announce a clinical trial for patients with diagnosed liver disease. It is very important that we as patients support this effort. It means having several blood tests but we are used to that and most importantly we can find out just how well the vaccine protects us. The link to sign up is below. I urge you to participate.

    Read more

  • published ELF in noninvasive tests 2021-02-10 15:18:37 -0700

    ELF

    Enhanced Liver Fibrosis (ELF) Panel

    What it measures: fibrosis

    Who should take it: diagnosed NAFLD/NASH patients

    Where to get it: Europe

    The Enhanced Liver Fibrosis (ELF) panel, is a blood test developed by Siemens Healthineers that measures fibrosis using serum markers. Though this test is not commercially available in the United States, ELF is typically used to assess the risk of progression to cirrhosis and liver-related clinical events, most commonly to diagnose advanced fibrosis, ≥F2, in patients with NAFLD/NASH.[1]

    The ELF test is a panel of three biomarkers: type III procollagen peptide (PIIINP), hyaluronic acid (HA), and tissue inhibitor of metalloproteinase-1 (TIMP1). These values are summarized into a single score, which can be compared to different thresholds for diagnosis. The thresholds recommended by Siemens are 7.7 (lower threshold) and 9.8 (higher threshold). Meta-analysis has shown that the lower threshold of 7.7 had a sensitivity of 0.93 and a specificity of 0.34; this means that 93% with advanced fibrosis will be identified, while 34% of those without advanced fibrosis will be identified.[2] The higher threshold of 9.8 showed a specificity of 0.86 and a sensitivity of 0.65; this means that 86% of those with advanced fibrosis will be identified, while 65% of those without advanced fibrosis will be identified. As you can see, the lower threshold ensures that more people with advanced fibrosis will be accurately identified, at the expense of accurately identifying those without advanced fibrosis.

    Interestingly, the National Institute for Health Care and Excellence (NICE), a guideline-publishing public health body in England, sets the threshold for ELF at 10.51. At this value, ELF demonstrates a specificity of 0.93 and sensitivity of 0.51.[3] In other words, a cutoff of 10.51 means that 93% of those with advanced fibrosis will be identified and 51% of those without advanced fibrosis will be identified.

    While it is important to consider the effects of these various thresholds, the prevalence of advanced fibrosis in a population also has a significant impact. How much advanced fibrosis is present in a population determines which threshold should be used. In settings with a low prevalence, ELF is a useful tool to rule out NAFLD/NASH patients from having advanced fibrosis and less certain when trying to rule in advanced cirrhosis. At a prevalence >30%, the ability of the test to accurately identify those with advanced cirrhosis is much lower.[4]

     

    [1] Vali, Yasmin et al., Enhanced liver fibrosis test for the non-invasive diagnosis of fibrosis in patients with NAFLD: A systematic review and meta-analysis, Journal of Hepatology, April 2020, doi: https://doi.org/10.1016/j.jhep.2020.03.036

    [2] Vali et al.

    [3] Vali et al.

    [4] Vali et al.


  • published Part 2: Non-Invasive Testing in Wellness Webinars 2021-02-09 11:46:16 -0700

    Part 2: Non-Invasive Testing

    CLICK HERE to view the recording of Wellness Webinar Part 2

    Welcome to Fatty Liver Foundation's Wellness Webinars Series. This six-part webinar series will deliver the latest research and medical information to people living with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their medical providers. Our goal is to keep the patient community up-to-date on medical research and to build an archive of the important historical evolution of the field, while creating a space for patients to have their questions answered by top experts.

    FLF believes independent, clear, timely, and accurate information is vital for empowering patients to help them develop self-awareness, self-care, make informed decisions about participating in clinical trials, and promote understanding that patients can be equal partners in their healthcare decisions.

    Are you ready to join us for part-two of the FLF Wellness Webinars Series? Our expert faculty will review and discuss non-invasive testing for patients with liver disease in a fireside chat format with the chance to answer your questions. This webinar will be limited to 100 registrants, sign up today to secure your spot!

    We look forward to your participation!

    Host: Wayne Eskridge, Co-Founder and CEO, Fatty Liver Foundation
    Moderator: Neeraj Mistry, MD, MPH, Chief Medical Officer, Fatty Liver Foundation
    Panelists: Dr. Andrew Moon and Prof. Ellie Barnes

    Contact us at [email protected] if you have any questions.


  • published Wellness Ambassadors 2021-02-01 16:26:52 -0700

    Wellness Ambassadors

    Here at FLF, we are growing our network of Wellness Ambassadors to help spread our message throughout the United States. These individuals have volunteered their time and effort to raise awareness about and garner support for NAFLD and NASH. Together, they are forming broad networks to help ensure the longevity and sustained impact of FLF.

    West Coast Ambassador: Te-Ping Sun

     


  • published Wellness Webinars in Webinars 2021-02-01 16:01:15 -0700

    Wellness Webinar Series

    Welcome to Fatty Liver Foundation's Wellness Webinars Series. This six-part webinar series will deliver the latest research and medical information to people living with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their medical providers. Our goal is to keep the patient community up-to-date on medical research and to build an archive of the important historical evolution of the field, while creating a space for patients to have their questions answered by top experts.

    FLF believes independent, clear, timely, and accurate information is vital for empowering patients to help them develop self-awareness, self-care, make informed decisions about participating in clinical trials, and promote understanding that patients can be equal partners in their healthcare decisions.

    Click on the banners to access the registration for an upcoming session or the recording of a past session.

     

    PART ONE: COVID-19 Vaccines and Liver Disease

     

    PART TWO: Non-Invasive Testing


  • Part 1: COVID-19 Vaccines and Liver Disease

    CLICK HERE to view the recording of Wellness Webinar Part 1

    Welcome to Fatty Liver Foundation's Wellness Webinars Series. This six-part webinar series will deliver the latest research and medical information to people living with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their medical providers. Our goal is to keep the patient community up-to-date on medical research and to build an archive of the important historical evolution of the field, while creating a space for patients to have their questions answered by top experts.

    FLF believes independent, clear, timely, and accurate information is vital for empowering patients to help them develop self-awareness, self-care, make informed decisions about participating in clinical trials, and promote understanding that patients can be equal partners in their healthcare decisions.

    Are you ready to join us for part-one of the FLF Wellness Webinars Series? Our expert faculty will review and discuss COVID-19 vaccinations for patients with liver disease in a fireside chat format with the chance to answer your questions. This webinar will be limited to 100 registrants, sign up today to secure your spot!

    We look forward to your participation!

    Host: Wayne Eskridge, Co-Founder and CEO, Fatty Liver Foundation
    Moderator: Neeraj Mistry, MD, MPH, Chief Medical Officer, Fatty Liver Foundation
    Panelists: Dr. Andrew Moon and Prof. Ellie Barnes

    Contact us at [email protected] if you have any questions.


  • published Part 4: Year in Review in LIVER Webinar Series 2021-02-01 15:50:25 -0700

    Part 4: Year in Review

    ARE YOU A PATIENT LIVING WITH NAFLD/NASH OR HEALTHCARE PROFESSIONAL CARING FOR NAFLD/NASH PATIENTS?

    Welcome to Fatty Liver Foundation's LIVER (Live Interactive Virtual Education and Review) Webinar Series. This four-part webinar series will deliver the latest research and medical information to people living with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their medical providers. Our goal is to keep the patient community up-to-date on medical research and to build an archive of the important historical evolution of the field.

    FLF believes independent, clear, timely, and accurate information is vital for empowering patients to help them develop self-awareness, self-care, make informed decisions about participating in clinical trials, and promote understanding that patients can be equal partners in their healthcare decisions.

    Are you ready to join us for part-four of the FLF LIVER Webinar Series? Our expert faculty will review and discuss highlights from this past year in a fireside chat format with the chance to answer your questions. This webinar will be limited to 100 registrants, sign up today to secure your spot!

    We look forward to your participation!

    Host: Wayne Eskridge, Co-Founder and CEO, Fatty Liver Foundation
    Moderator: Neeraj Mistry, MD, MPH, Chief Medical Officer, Fatty Liver Foundation

    Contact us at [email protected] if you have any questions.

     

    CLICK HERE to view the recording of LIVER 4


  • published Part 3: AASLD TLMdX 2020 in LIVER Webinar Series 2021-02-01 15:49:59 -0700

    Part 3: AASLD TLMdX 2020

    ARE YOU A PATIENT LIVING WITH NAFLD/NASH OR HEALTHCARE PROFESSIONAL CARING FOR NAFLD/NASH PATIENTS?

    Welcome to Fatty Liver Foundation's LIVER (Live Interactive Virtual Education and Review) Webinar Series. This four-part webinar series will deliver the latest research and medical information to people living with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their medical providers. Our goal is to keep the patient community up-to-date on medical research and to build an archive of the important historical evolution of the field.

    FLF believes independent, clear, timely, and accurate information is vital for empowering patients to help them develop self-awareness, self-care, make informed decisions about participating in clinical trials, and promote understanding that patients can be equal partners in their healthcare decisions.

    Are you ready to join us for part-three of the FLF LIVER Webinar Series? Our expert faculty will review and discuss highlights from the AASLD The Liver Meeting Digital Experience (TLMdX) 2020 and answer your questions.

    We look forward to your participation!

    Host: Wayne Eskridge, Co-Founder and CEO, Fatty Liver Foundation
    Moderator: Neeraj Mistry, MD, MPH, Chief Medical Officer, Fatty Liver Foundation

    Contact us at [email protected] if you have any questions.

    AGENDA*

    12:00 pm – 12:10 pm

    WELCOME AND INTRODUCTION

    Host – Wayne Eskridge, Fatty Liver Foundation

    Moderator – Neeraj Mistry, MD, MPH, Fatty Liver Foundation

    12:10 pm – 12:30 pm

    SESSION 1: LIFESTYLE AND DIET

    New Data on Lifestyle and Dietary Interventions in NAFLD/NASH Management

    Presenter – Meagan Gray, MD, University of Alabama at Birmingham

    Q&A – Neeraj Mistry, MD, MPH, Fatty Liver Foundation

    12:30 pm – 12:50 pm

    SESSION 2: TESTING

    Advances in Non-Invasive Biomarkers for Diagnosis and Monitoring of NAFLD/NASH

    Presenter – Meena Bansal, MD, Icahn School of Medicine at Mount Sinai, 

    Population Health for Quality and Efficiency Mount Sinai Health Partners

    Q&A – Neeraj Mistry, MD, MPH, Fatty Liver Foundation

    12:50 pm – 01:10 pm

    SESSION 3: TREATMENT

    Update on Investigational Drugs and Therapeutic Targets for NAFLD/NASH

    Presenter – Raymond Chung, MD, Harvard Medical School, Massachusetts General Hospital

    Q&A – Neeraj Mistry, MD, MPH, Fatty Liver Foundation

    01:10 pm – 01:15 pm

    REFLECTIONS AND TAKEAWAY POINTS

    Wayne Eskridge, Fatty Liver Foundation

     

    *Subject to change. This educational program is supported by grants from Intercept Pharmaceuticals, Madrigal Pharmaceuticals, and NetNoggin. Fatty Liver Foundation maintains editorial control and independence over the educational program content.

     

    CLICK HERE to view the recording of LIVER 3


  • published Part 2: Paris NASH 2020 in LIVER Webinar Series 2021-02-01 15:49:35 -0700

    Part 2: Paris NASH 2020

    paris-2020-banner.png

    ARE YOU A PATIENT LIVING WITH NAFLD/NASH OR HEALTHCARE PROFESSIONAL CARING FOR NAFLD/NASH PATIENTS?

     

    Welcome to Fatty Liver Foundation’s LIVER (Live Interactive Virtual Education and Review) Webinar Series. This four-part webinar series will deliver the latest research and medical information, including lifestyle/diet, testing and treatment, to people living with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their medical providers. Our goal is to keep the patient community up-to-date on medical research and to build an archive of the important historical evolution of the field.

     

    Join us for part-two of this webinar series on October 28, 2020 at 12:00 pm EDT hosted by Wayne Eskridge, our Co-Founder and CEO, along with Dr. Neeraj Mistry, our Chief Medical Officer, and a panel of leading clinicians and experts featuring Drs. Manal Abdelmalek, Amreen Dinani, and Arun Sanyal who will review and discuss highlights from the 6th Paris NASH Meeting 2020 and answer your questions.

     

    To register for and participate in this free webinar, please visit www.fattyliverfoundation.org or email us at [email protected]. We look forward to your participation!

     

    AGENDA*

    12:00 pm – 12:10 pm

    WELCOME AND INTRODUCTION

    Host – Wayne Eskridge, Fatty Liver Foundation

    Moderator – Neeraj Mistry, MD, MPH, Fatty Liver Foundation

    12:10 pm – 12:30 pm

    SESSION 1: LIFESTYLE AND DIET

    New Data on Lifestyle and Dietary Interventions in NAFLD/NASH Management

    Presenter – Amreen Dinani, MD, Icahn School of Medicine at Mount Sinai

    Q&A – Neeraj Mistry, MD, MPH  

    12:30 pm – 12:50 pm

    SESSION 2: TESTING

    Advances in Non-Invasive Biomarkers for Diagnosis and Monitoring of NAFLD/NASH

    Presenter – Arun Sanyal, MD, Virginia Commonwealth University School of Medicine

    Q&A – Neeraj Mistry, MD, MPH

    12:50 pm – 01:10 pm

    SESSION 3: TREATMENT

    Update on Investigational Drugs and Therapeutic Targets for NAFLD/NASH

    Presenter – Manal Abdelmalek, MD, MPH, Duke University

    Q&A – Neeraj Mistry, MD, MPH

    01:10 pm – 01:15 pm

    REFLECTIONS AND TAKEAWAY POINTS

    Wayne Eskridge

     

    *Subject to change. This educational program is supported by grants from Intercept Pharmaceuticals, Madrigal Pharmaceuticals, and NetNoggin. Fatty Liver Foundation maintains editorial control and independence over the educational program content.

     

    CLICK HERE to view the recording of LIVER 2


  • Part 1: EASL Digital International Liver Congress 2020

    ARE YOU A PATIENT LIVING WITH NAFLD/NASH OR HEALTHCARE PROFESSIONAL CARING FOR NAFLD/NASH PATIENTS?

     

    Welcome to Fatty Liver Foundation’s LIVER (Live Interactive Virtual Education and Review) Webinar Series. This four-part webinar series will deliver the latest research and medical information, including lifestyle/diet, testing and treatment, to people living with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their medical providers. Our goal is to keep the patient community up-to-date on medical research and to build an archive of the important historical evolution of the field.

     

    Join us for part-one of this webinar series on Sep 2, 2020 12:00 PM EDT hosted by Wayne Eskridge, our Co-Founder and CEO, along with Dr. Neeraj Mistry, our Chief Medical Officer, and a panel of leading clinicians and experts featuring Drs. Nadege Gunn, Brent Neuschwander-Tetri, and Scott Friedman who will review and discuss highlights from the EASL Digital Liver Conference 2020 and answer your questions.

     

    To register for and participate in this free webinar, please visit www.fattyliverfoundation.org or email us at [email protected]. We look forward to your participation!

     

    AGENDA*

    12:00 pm – 12:10 pm

    WELCOME AND INTRODUCTION

    Host – Wayne Eskridge, Fatty Liver Foundation

    Moderator – Neeraj Mistry, MD, MPH, Fatty Liver Foundation

    12:10 pm – 12:30 pm

    SESSION 1: LIFESTYLE AND DIET

    New Data on Lifestyle and Dietary Interventions in NAFLD/NASH Management

    Presenter – Nadege Gunn, MD, Texas A&M College of Medicine, Pinnacle Clinical Research, Austin Gastroenterology

    Q&A – Neeraj Mistry, MD, MPH, Fatty Liver Foundation 

    12:30 pm – 12:50 pm

    SESSION 2: TESTING

    Advances in Non-Invasive Biomarkers for Diagnosis and Monitoring of NAFLD/NASH

    Presenter – Brent A. Neuschwander-Tetri, MD, NASH Studies Unit, Saint Louis University School of Medicine

    Q&A – Moderator – Neeraj Mistry, MD, MPH, Fatty Liver Foundatoin

    12:50 pm – 01:10 pm

    SESSION 3: TREATMENT

    Update on Investigational Drugs and Therapeutic Targets for NAFLD/NASH

    Presenter – Scott L. Friedman, MD, Icahn School of Medicine at Mount Sinai

    Q&A – Moderator – Neeraj Mistry, MD, MPH

    01:10 pm – 01:15 pm

    REFLECTIONS AND TAKEAWAY POINTS

    Wayne Eskridge

     

    *Subject to change. This educational program is supported by grants from Intercept Pharmaceuticals, Madrigal Pharmaceuticals, and NetNoggin. Fatty Liver Foundation maintains editorial control and independence over the educational program content.'

     

    CLICK HERE to view the recording of LIVER 1


  • published LIVER Webinar Series in Webinars 2021-02-01 15:48:54 -0700

    LIVER Webinar Series

    Welcome to Fatty Liver Foundation's LIVER (Live Interactive Virtual Education and Review) Webinar Series. This four-part webinar series will deliver the latest research and medical information to people living with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their medical providers. Our goal is to keep the patient community up-to-date on medical research and to build an archive of the important historical evolution of the field.

    The series concluded in January 2021. Please click the banners below to access the recordings of each webinar.


  • published APRI in noninvasive tests 2020-12-21 13:44:16 -0700

    APRI

    APRI 

    What it measures: fibrosis

    Who should take it: anyone concerned about their liver

    Where to get it: primary care provider, online calculator

    AST to Platelet Ratio Index (APRI) is a blood-based liver test based on the amount of aspartate aminotransferase (AST) and platelets in a person’s body. APRI score measures the amount of fibrosis in the liver. AST is an enzyme that is typically found in low levels in the body; elevated AST levels are caused by a damaged liver and usually indicate cirrhosis. Platelets are blood cells that help heal wounds and stop heavy bleeding; the normal range is 150,000 to 400,000 per microliter (mcL) of blood. Low platelet counts are anything under 150,000/mcL and are usually found in people with cirrhosis. The calculation for APRI can be seen in the following image:

    To understand APRI scores, the numbers to keep in mind are 0.5 and 1.5. The lower the score (less than 0.5), the greater the negative predictive value, or the ability to rule out cirrhosis. The higher the score (greater than 1.5), the greater the positive predictive value, or the ability to rule in cirrhosis. A score between 0.5 and 1.5 is indeterminate and requires further testing.[1] It is important to note that APRI alone is probably not sensitive enough to rule out significant disease, and that using multiple tests in combination can help increase diagnostic accuracy.[2]

    Though it is not the most specific or sensitive test, it is widely available through analysis of routine bloodwork. If you have your AST and platelet count values from previous bloodwork, you can enter them yourself in the calculator here:

    CLICK HERE TO LINK TO APRI CALCULATOR PAGE

     

    [1] Chou and Wasson, Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review, Annals Internal Medicine, June 2013, doi: 10.7326/0003-4819-158-11-201306040-00005.

    [2] Chou and Wasson.


  • published FIB-4 Index in noninvasive tests 2020-12-07 09:56:02 -0700

    FIB-4 Index

    FIB-4 Index

    What it measures: fibrosis

    Who should take it: anyone concerned about their liver

    Where to get it: primary care provider, online calculator

    The FIB-4 Index is a blood-based diagnostic test that looks at underlying fibrosis that can be used as a measure to help determine NAFLD/NASH status. While originally developed to detect liver fibrosis among patients with Hepatitis C and HIV, FIB-4 scoring has been increasingly used by the diabetes and NAFLD/NASH communities.[1] [2] [3] The FIB-4 scoring system is determined from the values of patient age, platelet count, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). As all of these tests are available to primary care physicians, FIB-4 is a highly accessible and affordable screening tool. A sample report can be seen below:

    In clinical trials for NAFLD/NASH diagnosis, patients with a FIB-4 score <1.3 were classified as not having advanced fibrosis, while patients with a FIB-4 score >2.67 were classified as having advanced fibrosis.[4] Those with FIB-4 scores 1.3-2.6 were indeterminate, requiring further testing. As a test to rule out advanced fibrosis (FIB-4 <1.3), FIB-4 has a negative predictive value of 90-95%. This means that 90-95% of those identified as not having advanced fibrosis truly do not have advanced fibrosis, while the remaining 5-10% are false negatives requiring further validation. As a test to rule in advanced fibrosis (FIB-4 >2.6), FIB-4 has a positive predictive value of 80%. This means that 80% of those identified as having advanced fibrosis truly have advanced fibrosis, while the remaining 20% are false positives requiring further validation.

    Unlike some other tests, FIB-4 looks solely at fibrosis, not taking into consideration other factors important for diagnosis and monitoring of NAFLD/NASH such as steatosis and activity. While it is fairly limited in this sense, the high accuracy in detection of fibrosis makes it a strong starting point for NAFLD/NASH diagnosis that can help the right patients get on track for further testing and treatment. As all of these tests are readily available to primary care physicians, FIB-4 is a highly accessible and affordable screening tool. If you have your platelet count, AST, and ALT values from a previous bloodwork, you can enter them yourself in the calculator here:

    CLICK HERE TO LINK TO FIB-4 CALCULATOR PAGE

     

    [1] Sterling et al., Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection, Hepatology, June 2006, doi: 10.1002/hep.21178.

    [2] Filozof et al., Liver Fibrosis as Assessed by the FIB-4 Index in Patients with Type 2 Diabetes (T2DM), Diabetes, July 2018, doi: 10.2337/db18-1570-P.

    [3] Shah et al., USE OF THE FIB4 INDEX FOR NON-INVASIVE EVALUATION OF FIBROSIS IN NONALCHOLIC FATTY LIVER DISEASE, Clinical Gastroenterology and Hepatology, October 2009, doi: 10.1016/j.cgh.2009.05.033.

    [4] Alkhouri and McCullough, Noninvasive Diagnostics of NASH and Liver Fibrosis Within the Spectrum of NAFLD, Gastroenterology & Hepatology, October 2012.


  • published NIS4 in noninvasive tests 2020-11-23 10:27:04 -0700

    NIS4

    NIS4

    What it measures: activity, fibrosis

    Who should take it: diagnosed NAFLD/NASH patients

    Where to get it: clinical trials

    NIS4 is a blood-based diagnostic test developed by GENFIT that looks at liver activity and fibrosis to identify at-risk NASH patients. At-risk NASH patients are a subset of the general NAFLD/NASH population who are at a higher risk of progression to cirrhosis and adverse clinical outcomes. Because of the population subset being targeted, this test is not intended to be a screening test. These individuals have scores of NAFLD Activity Scores (NAS) ≥4 and Fibrosis Scores (F) ≥2.[1]

    Using the 4 biomarkers detailed in the above diagram, NIS4 uses its algorithm to assign patients a score from 0 to 1. Like other algorithm-based tests, the use of NIS4 eliminates concerns about variability between the diagnoses done by human pathologists.

    In clinical trials, patients with a NIS4 score <0.36 were classified as not having at-risk NASH, while patients with a NIS4 score >0.63 were classified as having at-risk NASH[2]. Those with NIS4 scores 0.36-0.63 were indeterminate, requiring further testing. As a test to rule out at-risk NASH (NIS4 .0.36), NIS4 has a negative predictive value of 77.9%. This means that 77.9% of those identified as not having at-risk NASH truly do not have at-risk NASH, while the remaining 22.1% are false negatives requiring further validation. As a test to rule in at-risk NASH (NIS4 >0.63), NIS4 has a positive predictive value of 79.2%. This means that 79.2% of those identified as having at-risk NASH truly do have at-risk NASH, while the remaining 20.8% are false positives requiring further validation.

    This test is not yet widely available to patients because the biomarkers are uncommon in the typical lab setting and it is not yet reimbursable by insurance. GENFIT is working with LabCorp to increase availability of biomarker collection in their labs and is hoping to begin introducing the test to the public early in 2021.

     

    [1] Harrison, Stephen et al., A blood-based biomarker panel (NIS4) for non-invasive diagnosis of non-alcoholic steatohepatitis and liver fibrosis: a prospective derivation and global validation study, The Lancet Gastroenterology & Hepatology, November 2020, doi: 10.1016/S2468-1253(20)30252-1.

    [2] Harrison et al.


  • published Susan's Story in Patient Stories 2020-11-19 10:38:53 -0700

    Susan Zuckerman-Seely's journey to life

    Screen_Shot_2020-11-19_at_3.27.45_PM.png

    I wanted to write to you and tell you that your website made a huge difference in my journey to better liver health. 

    Sometime prior to 2010 I was told that I had fatty liver. I don't even remember specifics. In 2013 my liver enzymes went so crazy that my GI doc was extremely concerned and ordered a biopsy.  I was never told the results of the biopsy. Nor did I ask. I got approved for gastric bypass surgery but canceled two days before deciding I would try and lose the weight myself.

    Read more

Executive Assistant & Program Coordinator @LiverSaver

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