As the NASH pandemic grows in the number and diversity of patient cases, one patient group receiving increased notice includes patients with "lean NASH," those with "normal" BMI levels (BMI<23 for Asians; BMI<25 for other racial groups). Last month, Gastroenterology published Best Practice recommendations for diagnosing and treating lean NASH. In this conversation, co-authors, Drs. Michelle Long and Mazen Noureddin join Louise Campbell and Roger Green to discuss how they came to undertake this assignment and to organize their thoughts.
The conversation starts with Mazen Noureddin discussing why he, Michelle and Joseph Lim wrote this paper (in his simple description, "we are asked for it," which, he notes, "we were quite excited about.") From there, Mazen and Michelle describe the actual process of organizing the article. First, they needed to align on a single definition of "lean" (they settled on BMI<23 for Asians and BMI<25 for other racial groups.) From there, they relied on clinical experience to develop a basic list of 15 best practice elements. These served as a foundation for their work. From there, they conducted an extensive literature review to clarify each element.
In response to a question from Roger, Mazen comments that there were few surprises in what they found, if any, largely because the work came from the co-authors' extensive clinical experience. Mazen talks about an experience with two Indian brothers to explain how straightforward the process can be, and also how detailed. They note that lean NASH is harder to diagnose and requires painstaking efforts to rule out more obscure diagnoses that might not come into play with overweight or obese steatohepatitis patients. As Mazen notes, "there is some art" in treating these patients.
Michelle shifts focus to the tables and charts they put together for the article. Her point: physicians are too busy to dive into the issues and possibilities the way the co-authors did. This made it important to provide clear, concise guidance with relevant data in a small number of charts and tables and a stepwise approach.
Louise Campbell joins the conversation to compliment the authors and comment on the clear synergy between these best practices and approaches for diagnosing non-lean patients. She then asks whether there are differences between different Asian populations. The conversation ends with Michelle stating that insufficient research on this issue exists and Mazen, while agreeing, noting that the relied on publications from India and other parts of Asia in building their practices.