Understanding Fatty Liver Disease: MASH (formally known as NASH)

Transcript

• 00:04So there are three main
• 00:05functions of the liver. The
• 00:07liver functions as kind of
• 00:08a big filter. It detoxifies
• 00:11anything that we eat that's
• 00:12bad, and it helps kind
• 00:13of to store and process
• 00:15a bunch of nutrients.
• 00:16In another sense, it also
• 00:17functions a bit like a
• 00:18warehouse.
• 00:19We tend to get nutrients
• 00:21in phases.
• 00:22During a phase of high
• 00:23nutrient supply, the liver will
• 00:24take the excess nutrients and
• 00:25store them typically as lipids.
• 00:26The liver also produces a
• 00:27ton of important proteins. You
• 00:28can kind of think of
• 00:28it as,
• 00:30manufacturing many of these different
• 00:31compounds. A good example of
• 00:32that would be
• 00:36good example of that would
• 00:37be clotting factors, which the
• 00:38body needs for the blood
• 00:39to clot.
• 00:41And I think a big
• 00:42portion of how the liver
• 00:44is important for metabolic health
• 00:46is it helps to determine
• 00:47what happens to a lot
• 00:49of the nutrients that that
• 00:50we're eating. The liver is
• 00:51not designed
• 00:53for a state of chronic
• 00:54overnutrition.
• 00:56And what's happened historically always
• 00:58has been is that we
• 00:59do have periods of overnutrition,
• 01:01say the higher base. But
• 01:02inevitably, historically, it's been followed
• 01:04by weeks and months where
• 01:05we have under nutrition and
• 01:07then we fall back on
• 01:08the body's reserves.
• 01:09Modern life, say, in the
• 01:10last hundred years has been
• 01:12very unusual that
• 01:13most of the population has
• 01:15had excess nutrition day after
• 01:18day after day, and that's
• 01:19what ends up causing damage
• 01:20to the liver and many
• 01:21other organs.
• 01:27MASH is metabolic
• 01:29dysfunction
• 01:30associated steatohepatitis.
• 01:32MASH is a term where
• 01:34there is chronic over nutrition,
• 01:37where the liver is storing
• 01:39these excess nutrients.
• 01:40What ends up happening is
• 01:41you get both fat as
• 01:43well as inflammation in the
• 01:45liver.
• 01:46If you let that fat
• 01:47and inflammation go inside of
• 01:49the liver for long periods
• 01:50of time, that scar tissue
• 01:52starts to build up and
• 01:53can lead to cirrhosis of
• 01:55the liver. Which is a
• 01:56very severe condition and unfortunately
• 01:58a life threatening situation.
• 02:04For the majority of patients,
• 02:06the development of MASH appears
• 02:07to be very strongly linked
• 02:09to the development of metabolic
• 02:11syndrome. So patients who are
• 02:13either overweight,
• 02:14have high blood pressure, diabetes,
• 02:17their lipids are abnormal,
• 02:19or they tend to put
• 02:20weight more centrally on their
• 02:21abdomen instead of distributing it
• 02:23across their body,
• 02:25that predisposes
• 02:26them to also taking some
• 02:27fat and putting it instead
• 02:29inside of the liver.
• 02:31Like many metabolic conditions, it
• 02:33is asymptomatic
• 02:35until it's too late.
• 02:37So that's why it's really
• 02:38important
• 02:39that whenever there are any
• 02:40indicators, and indicators may be
• 02:42things like
• 02:43blood test or ultrasounds,
• 02:46that that's taken seriously and
• 02:47we act upon it.
• 02:53As obesity
• 02:54and things like high blood
• 02:55pressure and diabetes
• 02:57are starting to rise inside
• 02:58of our country, we're starting
• 03:00to see a much higher
• 03:02prevalence of diseases like MASH.
• 03:04And unfortunately, we're starting to
• 03:06see a greater number of
• 03:08patients that that are developing
• 03:09cirrhosis
• 03:10as a result of having
• 03:12MASH.
• 03:13And the reason I think
• 03:13it's important to try to
• 03:15identify this early is we
• 03:16have much better treatment options
• 03:18now than even when I
• 03:19was in training to help
• 03:20you to be able to
• 03:21manage your weight, as well
• 03:22as medicines that can actually
• 03:24help to take fat and
• 03:25get it out of your
• 03:26liver.
• 03:27So the medication, Riz Defra,
• 03:29that's been approved actually increases
• 03:31the metabolism in the liver
• 03:32and it mobilizes a lot
• 03:33of the fat in the
• 03:34liver. And the rationale there
• 03:36is that if we can
• 03:37take the
• 03:38stress away from the liver,
• 03:39so we can take the
• 03:40fat away from the liver
• 03:41and therefore stop ongoing injury,
• 03:43that the liver will then
• 03:44actually repair itself, which does
• 03:46tend to happen.
• 03:48At Yale, we have a
• 03:49dedicated fatty liver program where
• 03:51we take care of patients
• 03:52that have fatty liver from
• 03:54any causes, and we work
• 03:56in a big group of
• 03:57providers to try to be
• 03:58able to find a tailored
• 04:00regimen for patients to be
• 04:01able to help them get
• 04:03rid of their MASH
• 04:05and make it so that
• 04:06their risk of developing cirrhosis
• 04:08down the line is as
• 04:09low as possible.
• 04:12So I think with approval
• 04:14of a new drug, we
• 04:15need to be more aware
• 04:16of the patients that are
• 04:17out there. And I would
• 04:19suspect less than one out
• 04:22of ten patients who have
• 04:23MASH are actually aware of
• 04:25it. Most of them are
• 04:26just going about without realizing
• 04:28that they have MASH.
• 04:31I think it's important to
• 04:32talk to your primary care
• 04:34provider and ask them whether
• 04:35or not you should be
• 04:36screened for the presence of
• 04:37this disease and whether or
• 04:38not referral to a specialty
• 04:40clinic would be important.