On this episode, join experts Mazen Noureddin, MD, MHS (Transplant Hepatologist and Professor of Medicine at Houston Methodist Hospital), Kris Kowdley, MD (Director, Liver Institute Northwest) and Mitchell Shiffman, MD, (Hepatologist, Bon Secours Health System in Richmond, Virginia), as they discuss the importance of identifying and referring patients at risk for MASH with clinically significant fibrosis (≥F2). Our experts will discuss the liver specialist perspective on the urgency for specialty referral of appropriate patients, including the increased morbidity and mortality associated with advancing liver fibrosis. They will explain ways to identify patients at risk for clinically significant fibrosis and will discuss how lifestyle modification and management of cardiometabolic comorbidities when present, may reduce the risk of progression to clinically significant fibrosis. They will also provide an overview of the importance of multidisciplinary collaboration and highlight the key role of primary care providers and endocrinologists as the front line for identification of patients before MASH progresses to clinically significant fibrosis.

This program is intended for clinicians in the US only. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:

Mazen Noureddin, MD, MHS
Transplant Hepatologist and Professor of Medicine
Houston Methodist Hospital
Houston, TX

Kris Kowdley, MD, FACP, FACG, FASGE, AGAF, GAASLD
Director, Liver Institute Northwest
Professor, Elson S. Floyd College of Medicine, Washington State University
Seattle, WA

Mitchell Shiffman, MD
Hepatologist, Transplant Hepatology
Bon Secours Health System
Richmond, VA

Click here for full reference list

References

Charlton M, Tonnu-Mihara I, Teng CC, et al. The clinical and economic burdens of metabolic dysfunction-associated steatohepatitis. J Med Econ. 2024;2:1–41.

Cusi K, Budd J, Johnson E, Shubrook J. Making sense of the nonalcoholic fatty liver disease clinical practice guidelines: what clinicians need to know. Diabetes Spectr. 2024;37(1):29–38.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528–562. 

Dezső K, Paku S, Kóbori L, Thorgeirsson SS, Nagy P. What makes cirrhosis irreversible?-consideration on structural changes. Front Med (Lausanne). 2022;9:876293.

Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547–1554.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123–133.

Heyens LJM, Busschots D, Koek GH, Robaeys G, Francque S. Liver fibrosis in non-alcoholic liver disease: from liver biopsy to non-invasive biomarkers in diagnosis and treatment. Front Med (Lausanne). 2021;8:615978.

Hussain A, Patel PJ, Rhodes F, Srivastava A, Patch D, Rosenberg W. Decompensated cirrhosis is the commonest presentation for NAFLD patients undergoing liver transplant assessment. Clin Med (Lond). 2020;20(3):313–318.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657–1669.

Koh JH, Chee D, Ng CH, et al. Sex-based disparities in liver transplantation for hepatocellular carcinoma and the impact of the growing burden of NASH. Transplant Direct. 2024;10(7):e1642.

Lai M and Afdhal NH. Liver fibrosis determination. Gastroenterol Clin N Am. 2019;48(2):281–289.

Liver Foundation Website. Accessed July 15, 2024. https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-symptoms/

Loomba R, Wong R, Fraysee J, et al. Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data. Aliment Pharmacol Ther. 2020;51(11):1149–1159.

Muthiah MD, Cheng Han N, Sanyal AJ. A clinical overview of non-alcoholic fatty liver disease: a guide to diagnosis, the clinical features, and complications-what the non-specialist needs to know. Diabetes Obes Metab. 2022;24(Suppl 2):3–14.

Nagai S, Collins K, Chau LC, et al. Increased risk of death in first year after liver transplantation among patients with nonalcoholic steatohepatitis vs liver disease of other etiologies. Clin Gastroenterol Hepatol. 2019;17(13):2759–2768.e5.

Ng CH, Lim WH, Hui Lim GE, et al. Mortality outcomes by fibrosis stage in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(4):931–939.

Noureddin M, Vipani A, Bresee C, et al. NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and ethnic and gender variances. Am J Gastroenterol. 2018;113(11):1649–1659.

Payne JY, Alkhouri N, Le P, et al. Prevalence of at-risk NASH and its association with metabolic syndrome in US adults with NAFLD, 2017-2018. Hepatol Commun. 2023;7(1):e0019.

Piazzolla VA, Mangia A. Noninvasive diagnosis of NAFLD and NASH. Cells. 2020;9(4):1005.

REZDIFFRA (resmetirom) [package insert]. West Conshohocken, PA: Madrigal Pharmaceuticals, Inc.; 2024.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797–1835. 

Sanyal AJ, Anstee QM, Trauner M, et al. Cirrhosis regression is associated with improved clinical outcomes in patients with nonalcoholic steatohepatitis. Hepatology. 2022;75(5):1235–1246.

Srivastava A, Gailer R, Tanwar S, et al. Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease. J Hepatol. 2019;71(2):371–378. 

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–378.

Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ. AGA clinical practice update on the role of noninvasive biomarkers in the evaluation and management of nonalcoholic fatty liver disease: expert review. Gastroenterology. 2023;165(4):1080–1088.

Wong RJ, Tran T, Kaufman H, Niles J, Gish R. Increasing metabolic co-morbidities are associated with higher risk of advanced fibrosis in nonalcoholic steatohepatitis. PLoS One. 2019;14(8):e0220612.

Younossi Z, Stepanova M, Ong JP, et al. Nonalcoholic steatohepatitis is the fastest growing cause of hepatocellular carcinoma in liver transplant candidates. Clin Gastroenterol Hepatol. 2019;17(4):748–755.e3.

Younossi ZM, Stepanova M, Al Shabeeb R, et al. The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease. Hepatol Commun. 2023;8(1):e0352.

On this episode, join experts Mazen Noureddin, MD, MHS (Transplant Hepatologist and Professor of Medicine at Houston Methodist Hospital), Rita Basu, MD (Endocrinologist and Endowed Professor of Diabetes Scienceat University of Alabama at Birmingham) and Mary Rinella, MD (Transplant Hepatologist and Professor of Medicine at The University of Chicago Medicine), as they explore the most recent MASH guidelines. The experts discuss the different guidelines available, examining their common features and subtle differences for patient screening and the management of MASLD and MASH. They then look to the future, highlighting the emerging data that may influence the next iterations of these guidance documents and inform clinical practice.

This program is intended for clinicians in the US only. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk Inc. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:
Mazen Noureddin, MD, MHS
Transplant Hepatologist and Professor of Medicine
Houston Methodist Hospital
Houston, TX

Rita Basu, MD
Endocrinologist and Endowed Professor of Diabetes Science
University of Alabama at Birmingham
Birmingham, AL

Mary Rinella, MD
Transplant Hepatologist and Professor of Medicine
The University of Chicago Medicine
Chicago, IL

Click here for full reference list

References
Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66(6):1138-1153.

American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2023. Diabetes Care. 2023;46(Suppl 1):S49-S67.

American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S52-S76.

Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357.

Cusi K, Budd J, Johnson E, Shubrook J. Making sense of the nonalcoholic fatty liver disease clinical practice guidelines: what clinicians need to know. Diabetes Spectr. 2024;37(1):29-38.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562. 

Dalal N, Catalli L, Miller SA, et al. BRIDGE to liver health: implementation of a group telehealth psychoeducational program through shared medical appointments for MASLD management. BMC Public Health. 2024;24(1):1546.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.

European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;S0168-8278(24)00329-5. doi: 10.1016/j.jhep.2024.04.031.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657-1669.

Kanwal F, Shubrook JH, Younossi Z, et al. Preparing for the NASH epidemic: a call to action. Obesity (Silver Spring). 2021;29:1401-1412.

Nadolsky K, Cryer DR, Articolo A, Fisher T, Schneider J, Rinella M. Nonalcoholic steatohepatitis diagnosis and treatment from the perspective of patients and primary care physicians: a cross-sectional survey. Ann Med. 2023;55(1):2211349.

Rezdiffra™ [package insert]. West Conshohocken, PA:Madrigal Pharmaceuticals; 2024.

Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.

Schattenberg JM, Lazarus JV, Newsome PN, et al. Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: a cost-of-illness analysis. Liver Int. 2021;41(6):1227-1242.

Stefano JT, Duarte SMB, Ribeiro Leite Altikes RG, Oliveira CP. Non-pharmacological management options for MAFLD: a practical guide.Ther Adv Endocrinol Metab. 2023;14:20420188231160394.

Tamaki N, Ahlholm N, Luukkonen PK, et al. Risk of advanced fibrosis in first-degree relatives of patients with nonalcoholic fatty liver disease. J Clin Invest. 2022;132(21):e162513.

Wada T, Zeniya M. Background of the FIB-4 index in Japanese non-alcoholic fatty liver disease. Intern Med. 2015;54(2):127-32. 

Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ. AGA clinical practice update on the role of noninvasive biomarkers in the evaluation and management of nonalcoholic fatty liver disease: expert review. Gastroenterology. 2023;165(4):1080-1088.

Woodard JS, Abrams GA. Increased prevalence of advanced metabolic dysfunction-associated steatotic liver disease fibrosis in Type 2 diabetics despite low-risk Fibrosis-4 index scores. J Endocrinol Metab. 2024;14(1):40-47.

On this episode, join experts Mazen Noureddin, MD, MHS (Transplant Hepatologist and Professor of Medicine at Houston Methodist Hospital), Jay Shubrook, DO, FACOFP, FAAFP (Diabetologist and Professor of Medicine at Touro University California) and Mohammad Siddiqui, MD (Gastroenterologist/Hepatologist and Associate Professor at Virginia Commonwealth University), in a discussion that highlights the significance of noninvasive tests in screening patients who are at risk for MASH. These experts enlighten us on how to incorporate the FIB-4 index in clinical practices for fibrosis risk assessment and how the scores generated are used to provide recommendations for further management approaches. The conversation further explores the strengths and limitations of using this test. Join us as we discuss the importance of screening for fibrosis using FIB-4.

This program is intended for clinicians in the US only. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk Inc. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:

Mazen Noureddin, MD, MHS
Transplant Hepatologist and Professor of Medicine
Houston Methodist Hospital
Houston, TX

Jay Shubrook, DO, FACOFP, FAAFP
Diabetologist and Professor of Medicine
Touro University
Vallejo, California

Mohammad Siddiqui, MD
Gastroenterologist/Hepatologist and Associate Professor
Virginia Commonwealth University
Richmond, Virginia

Click here for full reference list

References

American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S52-S76.

Cusi K, Budd J, Johnson E, Shubrook J. Making sense of the nonalcoholic fatty liver disease clinical practice guidelines: what clinicians need to know. Diabetes Spectr. 2024;37(1):29-38.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562. 

De Lorenzo S, Tovoli F, Mazzotta A, et al. Non-alcoholic steatohepatitis as a risk factor for intrahepatic cholangiocarcinoma and its prognostic role. Cancers (Basel). 2020;12(11):3182.

Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547-1554.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657-1669.

Ng CH, Lim WH, Hui Lim GE, et al. Mortality outcomes by fibrosis stage in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(4):931-939.

Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.

Srivastava A, Gailer R, Tanwar S, et al. Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease. J Hepatol. 2019;71(2):371-378.

Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ. AGA clinical practice update on the role of noninvasive biomarkers in the evaluation and management of nonalcoholic fatty liver disease: expert review. Gastroenterology. 2023;165(4):1080-1088.

On this episode, join experts Mazen Noureddin, MD, MHS (Transplant Hepatologist and Professor of Medicine at Houston Methodist Hospital), Sarah Enslin, PA-C, (Physician Assistant, Gastroenterology and Hepatology at the University of Rochester Medical Center), and Lisa Richards, FNP-BC, MSN (Hepatology Nurse Practitioner at the University of California San Diego), in a discussion on their approaches to educating patients about MASH and overall liver health. The conversation will examine the importance of educating patients on the disease and how effectively communicating with patients can help raise awareness of MASH, increase screening, and improve diagnosis rates and management of this condition. The experts will discuss best practices for educating patients on key aspects of MASLD and MASH, including understanding the disease, its prevalence, and progression. Furthermore, the conversation will explore the importance of patient and HCP conversations to improve early risk identification and impact overall liver health.

This program is intended for clinicians in the US only. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk Inc. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:

Mazen Noureddin, MD, MHS
Transplant Hepatologist and Professor of Medicine
Houston Methodist Hospital
Houston, TX

Sarah Enslin, PA-C
Physician Assistant, Gastroenterology and Hepatology
University of Rochester Medical Center
Rochester, NY

Lisa Richards, FNP-BC, MSN
Hepatology Nurse Practitioner
University of California San Diego
La Jolla, CA

Click here for full reference list

References
Alqahtani SA, Paik JM, Biswas R, Arshad T, Henry L, Younossi ZM. Poor awareness of liver disease among adults with NAFLD in the United States. Hepatol Commun. 2021;5(11):1833-1847.

American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S52-S76.

American Diabetes Association Professional Practice Committee. 6. Glycemic goals and hypoglycemia: Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S111–S125.

Bae JC. No more NAFLD: the term is now MASLD. Endocrinol Metab (Seoul). 2024;39(1):92-94.
Chakravarthy MV, Neuschwander-Tetri BA. The metabolic basis of nonalcoholic steatohepatitis. Endocrinol Diabetes Metab. 2020;3(4):e00112.

Chan WK, Chuah KH, Rajaram RB, Lim LL, Ratnasingam J, Vethakkan SR. Metabolic dysfunction-associated steatotic liver disease (MASLD): a state-of-the-art review. J Obes Metab Syndr. 2023;32(3):197-213.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562.

Dietrich CG, Rau M, Geier A. Screening for nonalcoholic fatty liver disease-when, who and how? World J Gastroenterol. 2021;27(35):5803-5821.

Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547-1554.

Eskridge W, Cryer DR, Schattenberg JM, et al. Metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis: the patient and physician perspective. J Clin Med. 2023;12(19):6216.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.

Forlano R, Sigon G, Mullish BH, Yee M, Manousou P. Screening for NAFLD-current knowledge and challenges. Metabolites. 2023;13(4):536.

Hajifathalian K, Mehta A, Ang B, et al. Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty. Gastrointest Endosc. 2021;93(5):1110-1118.

Heyens LJM, Busschots D, Koek GH, Robaeys G, Francque S. Liver fibrosis in non-alcoholic fatty liver disease: from liver biopsy to non-invasive biomarkers in diagnosis and treatment. Front Med (Lausanne). 2021;8:615978.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657-1669.

Kanwal F, Shubrook JH, Younossi Z, et al. Preparing for the NASH epidemic: a call to action. Gastroenterology. 2021;161(3):1030-1042.e8.

Lazarus JV, Mark HE, Anstee QM, et al. Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol. 2022;19(1):60-78.

Lee JH, Jang Jung H, Park H, et al. A survey on the awareness, current management, and barriers for non-alcoholic fatty liver disease among the general Korean population. Sci Rep. 2023;13(1):15205.

Loomba R, Wong R, Fraysee J, et al. Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data. Aliment Pharmacol Ther. 2020;51(11):1149-1159.

Muthiah MD, Cheng Han N, Sanyal AJ. A clinical overview of non-alcoholic fatty liver disease: a guide to diagnosis, the clinical features, and complications-what the non-specialist needs to know. Diabetes Obes Metab. 2022;24(Suppl 2):3-14.

Ng CH, Lim WH, Hui Lim GE, et al. Mortality outcomes by fibrosis stage in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(4):931-939.

Rezdiffra™ [package insert]. West Conshohocken, PA: Madrigal Pharmaceuticals; 2024.

Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.

Sanyal AJ, Anstee QM, Trauner M, et al. Cirrhosis regression is associated with improved clinical outcomes in patients with nonalcoholic steatohepatitis. Hepatology. 2022;75(5):1235-1246.

Schattenberg JM, Lazarus JV, Newsome PN, et al. Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: a cost-of-illness analysis. Liver Int. 2021;41(6):1227-1242.

Schulz M, Tacke F. Identifying high-risk NASH patients: what we know so far. Hepat Med. 2020;12:125-138.

Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic steatohepatitis: a review. JAMA. 2020;323(12):1175-1183.

Tapper EB, Krieger N, Przybysz R, et al. The burden of nonalcoholic steatohepatitis (NASH) in the United States. BMC Gastroenterol. 2023;23(1):109.

Tincopa MA, Wong J, Fetters M, Lok AS. Patient disease knowledge, attitudes and behaviours related to non-alcoholic fatty liver disease: a qualitative study. BMJ Open Gastroenterol. 2021;8(1):e000634.

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-378.

Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335-1347.

Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.

Zeng J, Fan JG, Francque SM. Therapeutic management of metabolic dysfunction associated steatotic liver disease. United European Gastroenterol J. 2024;12(2):177-186.

On this episode, join experts Mazen Noureddin, MD, MHS (Transplant Hepatologist and Professor of Medicine at Houston Methodist Hospital), Fernando Bril, MD (Endocrinologist and Assistant Professor of Medicine at University of Alabama at Birmingham) and Bubu Banini, MD, PhD, (Hepatologist/Gastroenterologist and Assistant Professor of Medicine at Yale), as they explore the connection between MASH and other metabolic diseases, including obesity and type 2 diabetes. The experts discuss the shared metabolic dysfunction among these conditions and the increased prevalence of MASH in patients with other cardiometabolic risk factors. As MASH is frequently (though not always) a progressive yet often asymptomatic disease, our experts provide their perspective on how understanding this metabolic connection can help HCPs better screen, diagnose, and manage patients who are at risk for MASH.

This program is intended for clinicians in the US only. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk Inc. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:

Mazen Noureddin, MD, MHS
Transplant Hepatologist and Professor of Medicine
Houston Methodist Hospital
Houston, TX

Bubu Banini, MD, PhD
Hepatologist/Gastroenterologist and Assistant Professor of Medicine
Yale University
New Haven, CT

Fernando Bril, MD
Endocrinologist and Assistant Professor of Medicine
University of Alabama at Birmingham
Birmingham, AL

Click here for full reference list

References

Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66(6):1138-1153.

Alexander L. The benefits of obesity medicine certification. Am J Lifestyle Med. 2018;13(2):161-164.

American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S52-S76.

Aminian A, Al-Kurd A, Wilson R, et al. Association of bariatric surgery with major adverse liver and cardiovascular outcomes in patients with biopsy-proven nonalcoholic steatohepatitis. JAMA. 2021;326(2):2031-2042.

Barb D, Repetto EM, Stokes ME, Shankar SS, Cusi K. Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease. Obesity (Silver Spring). 2021;29(11):1950-1960.

Bril F, Sanyal A, Cusi K. Metabolic syndrome and its association with nonalcoholic steatohepatitis. Clin Liver Dis. 2023;27(2):187-210.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562. 

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.

Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr. 2020;12:60.

Heyens LJM, Busschots D, Koek GH, Robaeys G, Francque S. Liver fibrosis in non-alcoholic fatty liver disease: from liver biopsy to non-invasive biomarkers in diagnosis and treatment. Front Med (Lausanne). 2021;8:615978.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657-1669.

Ng CH, Lim WH, Hui Lim GE, et al. Mortality outcomes by fibrosis stage in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(4):931-939.

Quek J, Chan KE, Wong ZY, et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20-30.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. 

Schattenberg JM, Lazarus JV, Newsome PN, et al. Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: a cost-of-illness analysis. Liver Int. 2021;41(6):1227-1242.

Shroff H, VanWagner LB. Cardiovascular disease in nonalcoholic steatohepatitis: screening and management. Curr Hepatol Rep. 2020;19(3):315-326.

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-e15.

Younossi ZM, Golabi P, de Avila L, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: a systematic review and meta-analysis. J Hepatol. 2019;71(4):793-801.

Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335-1347.

Zhang X, Yip TC, Tse YK, et al. Duration of type 2 diabetes and liver-related events in nonalcoholic fatty liver disease: a landmark 

What is the journey for a patient with MASH? Please join experts Mazen Noureddin, MD, MHS (Transplant Hepatologist and Professor of Medicine at Houston Methodist Hospital), Kenneth Cusi, MD, FACP, FACE (Endocrinologist and Professor of Medicine at the University of Florida) and Jay Shubrook, DO (Professor of the Primary Care Department at Touro University California) as they discuss patient care in MASH. They will examine the importance of early identification, the tools available to assist with this, and the management options available once fibrosis risk has been assessed. They will also provide insight into the importance of a multidisciplinary approach to ensure holistic management of the disease.

This program is intended for clinicians in the US. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:

Mazen Noureddin, MD, MHS
Transplant Hepatologist and Professor of Medicine
Houston Methodist Hospital
Houston, TX

Kenneth Cusi, MD, FACP, FACE
Endocrinologist and Professor of Medicine
University of Florida
Gainesville, FL

Jay Shubrook, DO
Professor of the Primary Care Department
Touro University California
Vallejo, CA

Click here for full reference list

References

American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S52-S76.

Barb D, Repetto EM, Stokes ME, Shankar SS, Cusi K. Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease. Obesity (Silver Spring). 2021;29(11):1950-1960.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562. 

Dhamija E, Paul SB, Kedia S. Non-alcoholic fatty liver disease associated with hepatocellular carcinoma: An increasing concern. Indian J Med Res. 2019;149(1):9-17.

Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547-1554.

Eskridge W, Cryer DR, Schattenberg JM, et al. Metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis: the patient and physician perspective. J Clin Med. 2023;12(19):6216.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.

Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr. 2020;12:60.

Hamid O, Eltelbany A, Mohammed A, Alsabbagh Alchirazi K, Trakroo S, Asaad I. The epidemiology of non-alcoholic steatohepatitis (NASH) in the United States between 2010-2020: a population-based study. Ann Hepatol. 2022;27(5):100727.

Harrison SA, Gawrieh S, Roberts K, et al. Prospective evaluation of the prevalence of non-alcoholic fatty liver disease and steatohepatitis in a large middle-aged US cohort. J Hepatol. 2021;75(2):284-291.

Huang DQ, Noureddin N, Ajmera V, et al. Type 2 diabetes, hepatic decompensation, and hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: an individual participant-level data meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(9):829-836.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657-1669.

Loomba R, Wong R, Fraysee J, et al. Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data. Aliment Pharmacol Ther. 2020;51(11):1149-1159.

Machado MV. MASLD treatment—a shift in the paradigm is imminent. Front Med (Lausanne). 2023;10:1316284.

Nadolsky K, Cryer DR, Articolo A, Fisher T, Schneider J, Rinella M. Nonalcoholic steatohepatitis diagnosis and treatment from the perspective of patients and primary care physicians: a cross-sectional survey. Ann Med. 2023;55(1):2211349.

Quek J, Chan KE, Wong ZY, et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20-30.

Rezdiffra™ [package insert]. West Conshohocken, PA: Madrigal Pharmaceuticals; 2024.

Rinella M, Cryer DR, Articolo A, Fisher T, Schneider J, Nadolsky K. Nonalcoholic steatohepatitis medical patient journey from the perspective of hepatologists, gastroenterologists and patients: a cross-sectional survey. BMC Gastroenterol. 2022;22(1):335.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.

Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556.

Schattenberg JM, Lazarus JV, Newsome PN, et al. Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: a cost-of-illness analysis. Liver Int. 2021;41(6):1227-1242.

Twiss J, Whalley D, Doward L, et al. Validation of NASH-CHECK: a novel patient-reported outcome measure for nonalcoholic steatohepatitis. J Patient Rep Outcomes. 2023;7(1):69.

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-378.

Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ. AGA clinical practice update on the role of noninvasive biomarkers in the evaluation and management of nonalcoholic fatty liver disease: expert review. Gastroenterology. 2023;165(4):1080-1088.

What is the connection between cardiometabolic dysfunction and MASH? Please join experts Mazen Noureddin, MD, MHS (Transplant Hepatologist and Professor of Medicine at Houston Methodist Hospital), Meagan Gray, MD (Transplant Hepatologist and Assistant Professor of Medicine at the University of Alabama at Birmingham) and Marcelo Kugelmas, MD, FAASLD, FACP (Director of Hepatology and Research at South Denver Gastroenterology), as they discuss the latest perspectives on MASH and how it can lead to improvements in patient care. The experts will provide insights on how to best use current guidelines to identify at-risk patients and how they collaborate with other specialists to manage underlying cardiometabolic risk factors.

This program is intended for clinicians in the US. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:

Mazen Noureddin, MD, MHS
Transplant Hepatologist and Professor of Medicine
Houston Methodist Hospital
Houston, TX

Meagan Gray, MD
Transplant Hepatologist and Assistant Professor of Medicine
University of Alabama at Birmingham
Birmingham, AL

Marcelo Kugelmas, MD, FAASLD, FACP
Director of Hepatology and Research
South Denver Gastroenterology
Englewood, CO

Click here for full reference list

References

American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S52-S76.

Chakravarthy MV, Neuschwander-Tetri BA. The metabolic basis of nonalcoholic steatohepatitis. Endocrinol Diabetes Metab. 2020;3(4):e00112.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562. 

Dezső K, Paku S, Kóbori L, Thorgeirsson SS, Nagy P. What makes cirrhosis irreversible?-Consideration on structural changes. Front Med (Lausanne). 2022;9:876293.

Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547-1554.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657-1669.

Kidney Disease and Diabetes, American Heart Association. Accessed May 7, 2024. https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/kidney-disease--diabetes

Moorman AC, Xing J, Rupp LB, et al. CHeCS Investigators. Late diagnosis of hepatitis C virus infection, 2014-2016: continuing missed intervention opportunities. Am J Manag Care. 2019;25(8):369-374.

Nadolsky K, Cryer DR, Articolo A, Fisher T, Schneider J, Rinella M. Nonalcoholic steatohepatitis diagnosis and treatment from the perspective of patients and primary care physicians: a cross-sectional survey. Ann Med. 2023;55(1):2211349.

Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. 

Schattenberg JM, Lazarus JV, Newsome PN, et al. Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: a cost-of-illness analysis. Liver Int. 2021;41(6):1227-1242.

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-378.

Wong RJ, Tran T, Kaufman H, Niles J, Gish R. Increasing metabolic co-morbidities are associated with higher risk of advanced fibrosis in nonalcoholic steatohepatitis. PLoS One. 2019;14(8):e0220612.

Younossi ZM, Golabi P, de Avila L, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review 

Let’s dive into the world of MASH together. On the first episode of this series, please join experts Mazen Noureddin, MD, MHS (Transplant Hepatologist and Professor of Medicine at Houston Methodist Hospital), Amreen Dinani, MD, MSc (Hepatologist and Associate Professor of Medicine at Duke University) and Sonal Kumar, MD, MPH (Clinical Director of Hepatology and Gastroenterology at Weill Cornell Medical College), as they provide an overview of MASH (formerly called NASH). The experts will discuss the epidemiology and pathophysiology of MASH, including comorbidities, as well as the importance of recognizing MASH as a cardiometabolic disorder. The discussion will also explore the recent name change of the disease—from NASH to MASH—and how this may impact the landscape of screening, diagnosis, and management.

This program is intended for clinicians in the US only. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:

Mazen Noureddin, MD, MHS
Transplant Hepatologist and Professor of Medicine
Houston Methodist Hospital
Houston, TX

Amreen Dinani, MD, MSc
Hepatologist and Associate Professor of Medicine
Duke University
Durham, NC

Sonal Kumar, MD, MPH
Clinical Director of Hepatology and Gastroenterology
Weill Cornell Medical College
New York, NY

Click here for full reference list

References

American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S52-S76.

Chakravarthy MV, Neuschwander-Tetri BA. The metabolic basis of nonalcoholic steatohepatitis. Endocrinol Diabetes Metab. 2020;3(4):e00112.

Cusi K, Budd J, Johnson E, Shubrook J. Making sense of the nonalcoholic fatty liver disease clinical practice guidelines: What clinicians need to know. Diabetes Spectr. 2024;37(1):29-38.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562. 

Dufour JF, Caussy C, Loomba R. Combination therapy for non-alcoholic steatohepatitis: Rationale, opportunities and challenges. Gut. 2020;69(10):1877-1884.

Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547-1554.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.

Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr. 2020;12:60.

Goodman ZD. Grading and staging systems for inflammation and fibrosis in chronic liver diseases. J Hepatol. 2007;47(4):598-607. 

Heyens LJM, Busschots D, Koek GH, Robaeys G, Francque S. Liver fibrosis in non-alcoholic fatty liver disease: From liver biopsy to non-invasive biomarkers in diagnosis and treatment. Front Med (Lausanne). 2021:8:615978.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657-1669.

Liver Foundation. Accessed March 19, 2024. https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-definition-prevalence

Muthiah MD, Cheng Han N, Sanyal AJ. A clinical overview of non-alcoholic fatty liver disease: a guide to diagnosis, the clinical features, and complications-what the non-specialist needs to know. Diabetes Obes Metab. 2022;24(Suppl 2):3-14.

Ng CH, Lim WH, Hui Lim GE, et al. Mortality outcomes by fibrosis stage in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(4):931-939.

Noureddin M, Vipani A, Bresee C, et al. NASH leading cause of liver transplant in women: Updated analysis of indications for liver transplant and ethnic and gender variances. Am J Gastroenterol. 2018;113(11):1649-1659.

Piazzolla VA, Mangia A. Noninvasive diagnosis of NAFLD and NASH. Cells. 2020;9(4):1005.

Rinella M, Cryer DR, Articolo A, Fisher T, Schneider J, Nadolsky K. Nonalcoholic steatohepatitis medical patient journey from the perspective of hepatologists, gastroenterologists and patients: a cross-sectional survey. BMC Gastroenterol. 2022;22(1):335.

Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.

Schattenberg JM, Anstee QM, Caussy C, Bugianesi E, Popovic B. Differences between current clinical guidelines for screening, diagnosis and management of nonalcoholic fatty liver disease and real-world practice: A targeted literature review. Expert Rev Gastroenterol Hepatol. 2021;15(11):1253-1266.

Schattenberg JM, Lazarus JV, Newsome PN, et al. Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: a cost-of-illness analysis. Liver Int. 2021;41(6):1227-1242.

Sherif ZA. Unmasking a stealth killer: The need for increased awareness of NASH. Dig Dis Sci. 2020;65(4):987-989.

Shroff H, VanWagner LB. Cardiovascular disease in nonalcoholic steatohepatitis: Screening and management. Curr Hepatol Rep. 2020;19(3):315-326.

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-378.

Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335-1347.