Hepatology top 10 from 2021: NAFLD management, guideline updates, NASH treatment

Healio presents the following report on the top 10 hepatology peer-tested articles from 2021.

Coverage includes research on nonalcoholic fatty liver disease symptom management, guideline updates for drug-induced liver injury, nonalcoholic steatohepatitis data and more.

These top stories and more follow.

Plant-based Mediterranean diet cuts NAFLD by half

A Mediterranean diet combined with green plant-based proteins/polyphenols and restricted in red/processed meat may double intrahepatic fat loss and reduce nonalcoholic fatty liver disease by half, according to study results.

“In this trial, we introduce a new concept of a green Mediterranean diet, further enriched with specific green polyphenols as Mankai, green tea and walnuts and restrict in red and processed meat that might lead to significantly double intrahepatic fat loss, as compared with other healthy nutritional strategies,” Anat Yaskolka Meir, MPH, RD, of the department of epidemiology at Harvard T.H. Chan School of Public Health in Boston, and colleagues wrote. Read more.

Q&A: Nearly a third of obese adults with NAFLD achieve weight loss

During a follow-up of 39 months, 32% of overweight or obese patients with nonalcoholic fatty liver disease achieved 5% or greater weight loss, according to results published in Clinical Gastroenterology and Hepatology.

Twenty-five percent of these patients maintained 5% or greater weight loss. Read more.

ACG releases guidelines for managing suspected drug-induced liver injury

The ACG developed recommendations for diagnosis and management of idiosyncratic drug-induced liver injury.

“[Idiosyncratic drug-induced liver injury (DILI)] guidelines are important for clinicians because it provides evidence and experience-based recommendations for diagnosing and managing patients with suspected DILI in their practices,” Naga P. Chalasani, MD, of the department of medicine at Indiana University School of Medicine, told Healio. “With new medications and herbal and dietary agents becoming rapidly available, this guideline will assist gastroenterologists and hepatologists in managing their patients with suspected DILI.” Read more.

NASH in US estimated to cost more than $175 billion over next 2 decades

Based on the current number of cases of nonalcoholic steatohepatitis in the United States, more than $175 billion will be spent on managing and treating the disease, two-thirds being spent in those with obesity and NASH, according to a presentation.

“Based on data from meta-analysis, modeling and global burden of disease or GBD, the global burden of NASH is driven by the growing epidemic of obesity and type 2 diabetes,” Zobair M. Younossi, MD, MPH, chairman of the department of medicine at the Inova Fairfax Medical Campus in Virginia, said during his presentation at The Liver Meeting Digital Experience. “The growing prevalence of obesity and related NASH is projected to cause substantial clinical and economic burden in the United States over the next 2 decades.” Read more.

FDA grants fast track designation to CRV431 for NASH treatment

The FDA granted fast track designation to CRV431, a potent cyclophilin inhibitor, for the treatment of patients with nonalcoholic steatohepatitis, according to a release from Hepion Pharmaceuticals.

The designation allows sponsors to access drug approval reviews for serious and potentially life-threatening medical conditions and where there is an unmet need, according to the release. Read more.

Those with fatty liver at five times greater risk for death from COVID

Patients with metabolic-associated fatty liver disease or higher transaminases who were then diagnosed with COVID-19 were more likely to die, according to a presenter at the International Liver Congress.

“We have to consider that conditions with metabolic dysregulation such as [metabolic dysfunction-associated fatty liver disease (MAFLD)] and obesity that are characterized by low grade chronic inflammation could overlap with the acute inflammatory state caused by COVID-19 infection resulting in an immune system dysregulation with excessive release of inflammatory mediators and a cytokine storm that could lead to more severe condition for COVID-19 even to multiple organ failures,” Martín Uriel Vázquez Medina, MD, of the Escuela Superior de Medicina, said during a press conference. Read more.

Novel MAFLD criteria increases identification of fatty liver disease

Researchers identified more patients with fatty liver disease using novel metabolic dysfunction-associated fatty liver disease criteria compared with nonalcoholic fatty liver disease criteria.

“FLD has become the most common chronic liver disease globally with prevalence of over 25% and one of the major causes for cirrhosis and hepatocellular carcinoma,” Laurens van Kleef, MS, of Erasmus University Medical Center in Rotterdam, the Netherlands, said at the Digital NAFLD Summit 2021. “Recently, a transition from NAFLD to MAFLD has been proposed to shift the focus to metabolic health. The novel definition requires the presence of metabolic dysfunction together with hepatic steatosis; this transition to MAFLD has not yet been studied extensively.” Read more.

AGA issues new guidance on palliative care management in cirrhosis

The AGA published a new clinical practice update on palliative care management in patients with cirrhosis.

“Associated with a high burden of physical and psychological symptoms even in the compensated state, the quality of life of patients [with cirrhosis] with worsening disease severity parallels that of patients with advanced cancer,” Puneeta Tandon, MD, MSc, pf the division of gastroenterology at the University of Alberta in Alberta, Canada, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Despite this high symptom burden and chance for acute unexpected deteriorations in their disease course, rates of advance care planning and goals of care directives remain low, symptom management is suboptimally addressed and specialty palliative care and hospice referrals occur infrequently and late in the course of the disease.” Read more.

Persistent passive smoking exposure increases NAFLD risk

Exposure to passive smoking from childhood through adulthood was associated with increased risk for nonalcoholic fatty liver disease, according to study results.

“Little is known about the long-term influence of passive smoking on fatty liver particularly when the exposure occurs at an early stage of life,” Feitong Wu, MD, of the Menzies Institute for Medical Research at the University of Tasmania in Australia, and colleagues wrote. “Using data from a 31-year prospective population-based cohort study, we aimed to examine the association between passive smoking in child and adult lives with adult risk of fatty liver.” Read more.

AGA issues guidelines for coagulation disorder management

The AGA published clinical practice guidelines in Gastroenterology for the management of coagulation disorders among patients with cirrhosis.

“Cirrhosis is a disease state that is accompanied by significant alterations in laboratory parameters. ... Based on this measured thrombocytopenia and coagulopathy, it has traditionally been assumed that these results convey a high risk of bleeding and, therefore, significantly increased risk for patients undergoing invasive procedures,” Robert S. O’Shea, MD, MSCE, of the Digestive Disease and Surgery Institute at Cleveland Clinic, and colleagues wrote. “However, it has become clear that this understanding underestimates the balanced nature of alterations in hemostasis associated with end-stage liver disease and that neither thrombocytopenia nor elevated prothrombin time/international normalized ratio necessarily predicts bleeding outcomes in most of these patients.” Read more.

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