MEEOM LIVER MONTH, November 2022
Part 1 with Money-back Guarantee*
 
Identification of NAFLD
 
While liver biopsy is the clinical standard for identifying NASH, non-invasive imaging is becoming more important for staging and quantifying disease.
 
Conventional ultrasound has low negative predictive value so is of limited use, especially for mild steatosis. CT scan lacks specificity and sensitivity, and exposes the patient to ionising radiation.
 
The controlled attenuation parameter provides a useful indication of NAFLD, but the de facto gold standard has become MRI-derived proton density fat fraction (MRI-PDFF), for its ability to quantify fat content. It is widely used for non-invasive screening for NAFLD in research studies.
 
Assessment of fibrosis relies on indirect biomarkers, primarily tissue stiffness. 1 It is assessed by elastography, with the vibration-controlled transient elastography (FibroScan) imaging machine the most commonly used. 2. Studies have shown that patients with higher liver stiffness also have higher liver-related mortality, suggesting that this is a prognostic biomarker.3 MRE has been shown to predict progression to advanced fibrosis (stage 3 or 4) with a higher degree of accuracy than FibroScan.4
 
Combination of various biomarkers in one imaging session could allow for assessment of degree of steatosis, inflammation and fibrosis, by using both MRE and PDFF.

"At-risk" NASH
As noted, a key challenge is identification of patients with fibrosis stage 2 or above, who are at greatly increased risk of disease progression and liver-related mortality.
 
The FAST score, which combines two imaging biomarkers (liver stiffness and CAP from the FibroScan, plus the circulating biomarker AST:ALT ratio) is being used to prescreen people for inclusion in clinical trials. A FAST score above 0.67 indicates biopsy, while below 0.35 would exclude people from the trial before biopsy.5 6 The main issue with FAST is low positive predictive value. Combining MRE with FIB-4 biomarkers (MEFIB) may help. A FIB-4 score of 1.6 or above, combined with MRE of 3.3 kPa or above, yields a 97.1 positive predictive value that a patient has fibrosis stage 2 or above and is therefore a candidate for treatment.7 The investigators believe a PPV above 90 negates the need for a biopsy altogether in these populations. MEFIB has been shown to be better than FAST in detecting at-risk NASH patients, among a cohort with biopsy-proven NAFLD.8
 
The use of either vibration-controlled transient elastography or MRE, with FIB-4 where needed, could separate out patients with NAFLD into low risk fibrotic NAFLD and high risk for progressive fibrosis.9
 
MEEOM's clinically significant treatment response
The MEEOM® approach is inclusive, effective and tailored to the needs of each individual. We do a rigorous assessment with each client at the beginning of treatment, to help us understand the person and the specific problems they want to address through treatment. 
 
At MEEOM® Precision Medicine, we provide evidence-based treatment plans that are tailored to the particular needs of each patient.
 
Please send us hospital diagnosis and medical test results.
 
The German Precision Medicine research team of MEEOM® will decide whether to accept the new case within three working days according to the report.
 
より健康的で、より尊敬され、そしてより幸せになります。
Healthier, Wealthier & Happier, MEEOM®.

Yours Truly,
 
Lisa Lee
Secretary-General 
MEEOM® WorldWide Health Systems
MEEOM® Precision Medicine
MEEOM® プレシジョンメディシン
meeomers@MeeomHealth.club
https://www.meeomhealth.club
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Chuo-ku
Tokyo 104-0031
 
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事実を話させてください。
 
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References
1. Dulai PS, Sirlin CB, Loomba R. MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: clinical trials to clinical practice. J Hepatol 2016;65:1006–16.
2.Tapper EB, Loomba R. Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD. Nat Rev Gastroenterol Hepatol 2018;15:274–82.
3. Boursier J, Vergniol J, Guillet A, et al. Diagnostic accuracy and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non-alcoholic fatty liver disease. J Hepatol 2016;65:570–8.
4. Loomba R, Wolfson T, Ang B, et al. Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology 2014;60:1920–8.
5. Newsome PN, Sasso M, Deeks JJ, et al. FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study. Lancet Gastroenterol Hepatol 2020;5:362–73.
6. Noureddin N, Alkhouri N, Brown KA, et al. Driving nonalcoholic steatohepatitis forward using the FibroScan aspartate aminotransferase score, but obey the traffic lights. Hepatology 2020;72:2228–30.
7. Jung J, Loomba RR, Imajo K, et al. MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis. Gut 2021;70:1946–53.
8. Tamaki N, Higuchi M, Kurosaki M, et al. Risk difference of Liver-Related and cardiovascular events by liver fibrosis status in nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2022;20:1171-1173.e2.
9. Hsu C, Caussy C, Imajo K, et al. Magnetic resonance vs transient elastography analysis of patients with nonalcoholic fatty liver disease: a systematic review and pooled analysis of individual participants. Clin Gastroenterol Hepatol 2019;17:630–7.