When did what is now MASLD/MASH first get recognized? What was a key moment in time illuminating the fact that over a third of Americans have NAFLD?
There were and still are many, many laudable prophesiers and protagonists, including providers and non-providers, medical centers, research organizations, and advocacy groups.
One that stands out is the AGA, and the following originative article and visionary authors, and a date now 1,310 days ago.
The seminal journal article on 09/20/2021 was in Gastroenterology – “Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease,” by Fasiha Kanwal, Jay H. Shubrook, Leon A. Adams, Kim Pfotenhauer, Vincent Wai-Sun Wong, Eugene Wright, Manal F. Abdelmalek, Stephen A. Harrison, Rohit Loomba, Christos S. Mantzoros, Elisabetta Bugianesi, Robert H. Eckel, Lee M. Kaplan, Hashem B. El-Serag, and Kenneth Cusi.
NASH was a prominent word then:
Consider their prescient prose–
“Approximately 37% of adults in the United States, and as many as 70% of individuals with type 2 diabetes (T2D), have nonalcoholic fatty liver disease (NAFLD). Nonalcoholic steatohepatitis (NASH), a subtype of NAFLD characterized by inflammation, ballooning, and Mallory’s hyaline on liver biopsy, can lead to hepatic fibrosis, cirrhosis, and hepatocellular cancer (HCC). Both NAFLD and NASH are also associated with an increased risk of cardiovascular disease, cardiovascular and liver-related mortality, and impaired health-related quality of life. Given NAFLD’s close association with T2D and obesity, the prevalence of both NAFLD and NASH is likely to continue to increase. In 2017–2018, the age-adjusted prevalence of obesity in US adults was estimated to be 42.4%, and by 2030 approximately 1 in 2 adults is expected to have obesity.
Most patients with NAFLD and NASH are seen in primary care or endocrine clinics. Although not all patients with NAFLD/NASH require secondary (ie, hepatology) care, not knowing which patients might benefit from such care and when to refer them results in inconsistent care processes and possibly poor outcomes. Optimal care of the growing population of patients with NAFLD and NASH requires clinicians from different specialties, including primary care, gastroenterology, hepatology, obesity management, and endocrinology, to co-manage the hepatic manifestations of the disease, as well as the comorbid metabolic traits and cardiovascular risk. Such a process could benefit from an algorithmic approach to NAFLD screening, diagnosis, and risk stratification. Clinical care pathways have been found to improve the quality of health care delivery in other areas of medicine.
For these reasons, the American Gastroenterological Association (AGA), in collaboration with members from professional societies, including the American Diabetes Association, American Osteopathic Association, Endocrine Society, and the Obesity Society, convened a multidisciplinary task force of 15 experts to develop an NAFLD/NASH Clinical Care Pathway. The resulting Pathway aims to provide practical guidance across the spectrum of care from screening and diagnosis to management of patients with NAFLD and NASH, facilitating value-based, efficient, and safe care that is consistent with evidence-based guidelines, and setting the stage for future studies to examine the outcomes of such pathways.”
The website is still here, and they made a cogent call to action–
“The AGA’s Call-to-Action initiative is a multidisciplinary effort to align gastroenterologists, hepatologists, endocrinologists, and primary care providers to improve diagnosis and management of NAFLD/NASH.”
Now today LiverRight has our Extend™ offering, whereby we help GI practices move to the forefront of convenient virtual diagnosis and care in adult liver disease, which their very own AGA spotted so clearly 3.6 years ago.
