In the Season 3 NAFLD Year-in-Review conversations series, Surfers Jörn Schattenberg, Louise Campbell and Roger Green embark on a string of interviews with a handful of Key Opinion Leaders who made headlines and advances in Fatty Liver disease in 2022. In this exclusive segment, Jeff Lazarus opens in full disclosure admitting that, overall, 2022 has been a tough year in health care as “everyone is overwhelmed” while we all try to emerge from the pandemic. Regarding the status of Fatty Disease, Jeff is more optimistic as this year witnessed movement outside of hepatology into the space of diabetes societies and primary care meetings. Such collaborative energy is needed “to understand the metabolic syndrome and not just silos.” Jeff goes on to cite a return to an in-person Wilton Park meeting as an example turning point for such synergies.
The conversation evolves to consider targets, goals, endpoints and some small distinctions between each in the framework of public health. Jeff notes that we will need what he describes as a “drugs-plus approach” to address Fatty Liver disease – similar to that vaccines were not the single defense in combating the COVID pandemic. While drug therapies may be the cornerstone for fatty liver disease, there remains the need for lifestyle interventions through diet and exercise. As Jeff indicates, this mission is larger than hepatology alone. While a wider net of stakeholders establish clinical care guidelines in the context of professional societies, there still lacks, in example, a technical strategy coming from an organization such as the W.H.O. Jeff believes establishing work around the Sustainable Development Goals is important in showing the connection between different targets and the liver. He extends this idea to connect socioeconomic variables to liver health outcomes.
The group also explores the idea that when drugs become available to market, treater interest picks up because there is encouragement from the fact that something that can be done. Jeff hopes this positive energy will also recruit more resources in the form of nutritionists and dieticians. He raises questions around imagining what new models of care look like, and how do we improve communications and teamwork. His response: the availability of drugs and the imminent availability of drugs will set fire to the changes that will need to follow. He adds comments on the importance of addressing the policy arena and ensuring policymakers and health authorities are aware of the potentially deadly, highly prevalent condition. They need to be aware that there are soon to be approved and available drugs, and that the majority of this population is undiagnosed. Jeff further reasons that Fatty Liver is in need of a more proactive approach that identifies and educates on the risks of disease progression before advanced fibrosis takes hold. As the conversation winds down, the group investigates the implications and process behind ongoing discussion on nomenclature.