Nonalcoholic Fatty Liver Disease

Fractyl Laboratories announced positive topline results from the phase 2 trial of Revita duodenal mucosal resurfacing, or DMR, a minimally invasive outpatient procedural therapy for patients with nonalcoholic fatty liver disease and type 2 diabetes, according to a press release.

Researchers found that patients with “lean” nonalcoholic fatty liver disease had altered gut microbiota profiles along with higher bile acid and fibroblast growth factor 19, or FGF19, levels compared with patients with overweight or obesity.

Approximately 30% of Americans have fatty liver disease often driven by obesity and alcohol use. Fatty liver disease leads to many other complications including fasting glucose impairment or diabetes, cardiovascular disease, certain cancers, and can exacerbate the effects of other liver diseases such as hepatitis C.

Adults with type 2 diabetes and higher C-peptide levels are more likely to develop simple nonalcoholic fatty liver disease and nonalcoholic steatohepatitis compared with those with lower levels, according to findings published in DiabetesMetabolism Research and Reviews. In contrast, those with higher C-peptide levels are less likely to have advanced fibrosis.

Nonalcoholic fatty liver disease correlated with an approximately 90% higher risk for liver and gastrointestinal cancers compared with patients without fatty liver disease, while the association between obesity without fatty liver disease and cancer was small.

Combined, diabetes, obesity and insulin resistance are the most common cause of preventable death in the United States, responsible for millions of deaths and more than $600 billion in health care costs. The Cardiometabolic Health Congress, the largest U.S.-based multidisciplinary conference centered on the management and prevention of CV and metabolic disease, is being held October 10 to 13 in Chicago for health care practitioners committed to joining the fight against cardiometabolic disease.

Increases in liver fat correlated with development of cardiovascular disease risk factors including incident diabetes and metabolic syndrome, according to results from a 6-year longitudinal study.

Nonalcoholic fatty liver disease fibrosis scores and Fibrosis-4 index scores increased longitudinally and at a higher rate in those with fatty liver and fibrosis stage 2 or higher compared with those with stage 1 or no fibrosis, according to data.

Prevalence of nonalcoholic fatty liver disease — and its more severe stage, nonalcoholic steatohepatitis, or NASH, in particular — is increasing in developed countries. The condition has surpassed alcoholism as a cause of cirrhosis and will soon be the primary cause of liver transplantation in the United States, exceeding hepatitis C, according to Kenneth Cusi, MD, FACP, FACE, chief of the division of endocrinology, diabetes and metabolism at University of Florida.

Before 2015, managing obesity was the realm of other specialties. Although gastroenterologists have traditionally dealt with some of the comorbidities of obesity, they were not in position to target the root cause and provide relief in the form of weight management. That changed with the clinical introduction and FDA approval of several devices and procedures for the endoscopic management of obesity and metabolic disease, putting GIs right in the middle of the obesity epidemic.