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  1. Article ; Online: Nonalcoholic fatty liver disease from a primary care perspective.

    Clark, Jeanne M / Cryer, Donna R H / Morton, Michelle / Shubrook, Jay H

    Diabetes, obesity & metabolism

    2023  Volume 25, Issue 6, Page(s) 1421–1433

    Abstract: Nonalcoholic fatty liver disease (NAFLD) affects up to one-third of the US population. Approximately one-fifth of patients with NAFLD have nonalcoholic steatohepatitis (NASH), characterized by hepatocyte damage and inflammation with or without fibrosis. ... ...

    Abstract Nonalcoholic fatty liver disease (NAFLD) affects up to one-third of the US population. Approximately one-fifth of patients with NAFLD have nonalcoholic steatohepatitis (NASH), characterized by hepatocyte damage and inflammation with or without fibrosis. NASH leads to greater risk of liver-related complications and liver-related mortality, with the poorest outcomes seen in patients with advanced fibrosis. NASH is also associated with other metabolic comorbidities and conveys an increased risk of adverse cardiovascular outcomes and extrahepatic cancers. Despite its high prevalence, NAFLD is frequently underdiagnosed. This is a significant concern, given that early diagnosis of NAFLD is a key step in preventing progression to NASH. In this review, we describe the clinical impact of NASH from the perspective of both the clinician and the patient. In addition, we provide practical guidance on the diagnosis and management of NASH for primary care providers, who play a pivotal role in the frontline care of patients with NASH, and we use case studies to illustrate real-world scenarios encountered in the primary care setting.
    MeSH term(s) Humans ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/diagnosis ; Non-alcoholic Fatty Liver Disease/epidemiology ; Liver/metabolism ; Fibrosis ; Comorbidity ; Primary Health Care
    Language English
    Publishing date 2023-03-24
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 1454944-x
    ISSN 1463-1326 ; 1462-8902
    ISSN (online) 1463-1326
    ISSN 1462-8902
    DOI 10.1111/dom.15016
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  2. Article ; Online: Nonalcoholic Fatty Liver Disease: Review of Management for Primary Care Providers.

    Basu, Rita / Noureddin, Mazen / Clark, Jeanne M

    Mayo Clinic proceedings

    2022  Volume 97, Issue 9, Page(s) 1700–1716

    Abstract: Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the United States and worldwide. The progressive form of NAFLD, nonalcoholic steatohepatitis (NASH), is a leading indication for liver transplant. ... ...

    Abstract Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the United States and worldwide. The progressive form of NAFLD, nonalcoholic steatohepatitis (NASH), is a leading indication for liver transplant. Comorbidities associated with NAFLD development and NASH include type 2 diabetes, obesity, metabolic syndrome, and dyslipidemia. Extrahepatic morbidity and mortality are considerable as NAFLD is associated with an increased risk of cardiovascular disease and chronic kidney disease. Once NAFLD is diagnosed, the presence of liver fibrosis is the central determinant of hepatic prognosis. Severe liver fibrosis requires aggressive clinical management. No pharmacologic agents have regulatory approval in the United States for the treatment of NAFLD or NASH. Management is centered on efforts to reduce underlying obesity (lifestyle, medications, surgical or endoscopic interventions) and metabolic derangements (prediabetes, type 2 diabetes, hypertension, hyperlipidemia, and others). Current pharmacologic therapy for NAFLD is limited mainly to the use of vitamin E and pioglitazone, although other agents are being investigated in clinical trials. Cardiovascular and metabolic risk factors must also be assessed and managed. Here, NAFLD evaluation, diagnosis, and management are considered in the primary care setting and endocrinology clinics.
    MeSH term(s) Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/therapy ; Humans ; Liver/pathology ; Liver Cirrhosis/complications ; Non-alcoholic Fatty Liver Disease/diagnosis ; Non-alcoholic Fatty Liver Disease/epidemiology ; Non-alcoholic Fatty Liver Disease/therapy ; Obesity/complications ; Obesity/epidemiology ; Obesity/therapy ; Primary Health Care ; United States
    Language English
    Publishing date 2022-06-23
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2022.04.005
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  3. Article ; Online: Role of Commercial Weight-Loss Programs in Medical Management of Obesity.

    Gudzune, Kimberly A / Clark, Jeanne M

    Endocrinology and metabolism clinics of North America

    2020  Volume 49, Issue 2, Page(s) 275–287

    Abstract: Rates of obesity counseling are low among physicians because of the lack of time and training in this area. In recognition of this challenge, recent national guidelines encourage physicians to refer patients with obesity to intensive, comprehensive ... ...

    Abstract Rates of obesity counseling are low among physicians because of the lack of time and training in this area. In recognition of this challenge, recent national guidelines encourage physicians to refer patients with obesity to intensive, comprehensive lifestyle programs to lose weight. Some commercial weight-loss programs meet these criteria, and this article reviews the evidence from randomized controlled trials regarding such programs' weight-loss efficacy and safety as well as glycemic outcomes among patients with and without diabetes mellitus. A discussion of how physicians might approach the referral process and continued management of patients participating in these programs is included.
    MeSH term(s) Evidence-Based Practice ; Humans ; Obesity/therapy ; Outcome Assessment, Health Care/statistics & numerical data ; Weight Reduction Programs/standards ; Weight Reduction Programs/statistics & numerical data
    Language English
    Publishing date 2020-04-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 92116-6
    ISSN 1558-4410 ; 0889-8529
    ISSN (online) 1558-4410
    ISSN 0889-8529
    DOI 10.1016/j.ecl.2020.02.006
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  4. Article: Nonalcoholic fatty liver disease and type 2 diabetes: a burgeoning problem with unclear solutions.

    Lazo, Mariana / Clark, Jeanne M

    Hepatobiliary surgery and nutrition

    2019  Volume 9, Issue 4, Page(s) 514–517

    Keywords covid19
    Language English
    Publishing date 2019-09-26
    Publishing country China (Republic : 1949- )
    Document type Editorial ; Comment
    ZDB-ID 2812398-0
    ISSN 2304-389X ; 2304-3881
    ISSN (online) 2304-389X
    ISSN 2304-3881
    DOI 10.21037/hbsn.2019.11.28
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  5. Article ; Online: Improving Diabetes Screening in the Primary Care Clinic.

    Tseng, Eva / Hsu, Yea-Jen / Nigrin, Candace / Clark, Jeanne M / Marsteller, Jill A / Maruthur, Nisa M

    Joint Commission journal on quality and patient safety

    2023  Volume 49, Issue 12, Page(s) 698–705

    Abstract: Background: In our suburban primary care clinic, the average rate of screening for diabetes among eligible patients was only 51%, similar to national screening data. We conducted a quality improvement project to increase this rate.: Methods: During ... ...

    Abstract Background: In our suburban primary care clinic, the average rate of screening for diabetes among eligible patients was only 51%, similar to national screening data. We conducted a quality improvement project to increase this rate.
    Methods: During the 6-month preintervention phase, we collected baseline data on the percentage of eligible patients screened per week (percentage of patients with hemoglobin A1c checked in the prior 3 years out of patients eligible for screening who completed a visit during the week). We then implemented a two-phase intervention. In phase 1 (approximately 8 months), we generated an electronic health record (EHR) report to identify eligible patients and pended laboratory orders for physicians to sign. In phase 2 (approximately 3 months), we replaced the phase 1 intervention with an EHR clinical decision support tool that automatically identifies eligible patients. We compared screening rates in the preintervention vs. intervention period. For phase 1, we also assessed laboratory completion rates and the laboratory results. We surveyed physicians regarding intervention acceptability and satisfaction at 3, 6, 9, and 12 months during the intervention period.
    Results: The weekly percentage of patients screened increased from an average of 51% in the preintervention phase to 65% in the intervention phase (p < 0.001). During phase 1, most patients underwent laboratory blood testing as recommended (83% within 3 months), and results were consistent with prediabetes in 23% and with diabetes in 4%. Overall, most physicians believed that the intervention appropriately identified patients due for screening and was helpful (100% of respondents agreed at 9 months vs. 71% at 3 months).
    Conclusion: We successfully implemented a systematic screening intervention involving a manual workflow and EHR tool and improved diabetes screening rates in our clinic.
    MeSH term(s) Humans ; Diabetes Mellitus/diagnosis ; Ambulatory Care Facilities ; Electronic Health Records ; Surveys and Questionnaires ; Mass Screening ; Primary Health Care
    Language English
    Publishing date 2023-07-31
    Publishing country Netherlands
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1189890-2
    ISSN 1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
    ISSN (online) 1938-131X ; 1549-425X
    ISSN 1553-7250 ; 1070-3241 ; 1549-3741
    DOI 10.1016/j.jcjq.2023.07.009
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  6. Article ; Online: Increased TLR/MyD88 signaling in patients with obesity: is there a link to COVID-19 disease severity?

    Cuevas, Ada M / Clark, Jeanne M / Potter, James J

    International journal of obesity (2005)

    2021  Volume 45, Issue 5, Page(s) 1152–1154

    Abstract: COVID-19 is a pandemic disease caused by a coronavirus, designed as SARS CoV-2, whose clinical presentation is widely variable, with most patients having mild or no symptoms, but others developing a malign disease with multi-organ failure and even death. ...

    Abstract COVID-19 is a pandemic disease caused by a coronavirus, designed as SARS CoV-2, whose clinical presentation is widely variable, with most patients having mild or no symptoms, but others developing a malign disease with multi-organ failure and even death. Accumulating data from different populations have shown that obesity is a risk factor for a severe evolution of the disease, however, the mechanisms that explain this association are not clearly understood. An ominous evolution of COVID-19 has been attributed to an exacerbated inflammatory response, designed as "cytokine storm" with augmented production of cytokines/chemokines through the activation of toll-like receptors (TLR) by pathogen-associated molecular patterns, that triggers an inflammatory downstream response, mediated in part by the adaptor molecule, myeloid differentiation factor 88 (MyD88). Previous studies have reported an increased expression of MyD88 and TLRs in people with obesity, mainly in those with metabolic complications. Therefore, we hypothesize, that an underlying increased Myd88/TLR signaling may predispose to patients with obesity to develop an exaggerated and dangerous inflammatory reaction against SARS CoV-2 infection, explaining at least in part, the higher severity of COVID-19. In addition, MyD88/TLR signaling in people with obesity could have a role in the development of several chronic diseases.
    MeSH term(s) COVID-19/complications ; COVID-19/immunology ; COVID-19/physiopathology ; Cytokine Release Syndrome/immunology ; Humans ; Myeloid Differentiation Factor 88/metabolism ; Obesity/complications ; Obesity/immunology ; Obesity/physiopathology ; Pandemics ; Risk Factors ; SARS-CoV-2 ; Signal Transduction/immunology ; Toll-Like Receptors/metabolism
    Chemical Substances MYD88 protein, human ; Myeloid Differentiation Factor 88 ; Toll-Like Receptors
    Language English
    Publishing date 2021-02-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 752409-2
    ISSN 1476-5497 ; 0307-0565
    ISSN (online) 1476-5497
    ISSN 0307-0565
    DOI 10.1038/s41366-021-00768-8
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  8. Article ; Online: Eating breakfast is associated with weight loss during an intensive lifestyle intervention for overweight/obesity.

    Duan, Daisy / Pilla, Scott J / Michalski, Kathy / Laferrère, Blandine / Clark, Jeanne M / Maruthur, Nisa M

    Obesity (Silver Spring, Md.)

    2022  Volume 30, Issue 2, Page(s) 378–388

    Abstract: Objective: This study examined whether breakfast consumption frequency (BCF) is associated with weight-loss outcomes in the Look AHEAD (Action for Health in Diabetes) trial.: Methods: Data from a subset of participants (n = 3,915) from Look AHEAD, a ... ...

    Abstract Objective: This study examined whether breakfast consumption frequency (BCF) is associated with weight-loss outcomes in the Look AHEAD (Action for Health in Diabetes) trial.
    Methods: Data from a subset of participants (n = 3,915) from Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) to diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, were analyzed. BCF was collected by yearly questionnaire. Multivariable linear regression models were used to estimate the association between average BCF and percentage weight change over 4 years, controlling for baseline sociodemographic, anthropometric, and diabetes-related variables. In separate models, adjustment for diet (n = 915) and physical activity level (n = 837) was performed in a subset of participants.
    Results: Four-year average BCF was similar in DSE (n = 1,916) and ILI (n = 1,999) arms (p = 0.14). Each 1-day higher average BCF was associated with an additional 0.5% weight loss in the ILI arm (p < 0.0001) but not in the DSE arm (p = 0.58). This association in the ILI arm remained significant after adjustment for diet (p = 0.02) but not after adjustment for physical activity (p = 0.36).
    Conclusions: Breakfast consumption was associated with greater weight loss in the active treatment group of an ILI, which may be mediated by increased physical activity.
    MeSH term(s) Adult ; Breakfast ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/therapy ; Humans ; Life Style ; Obesity/complications ; Obesity/therapy ; Overweight/complications ; Overweight/therapy ; Weight Loss
    Language English
    Publishing date 2022-01-20
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2230457-5
    ISSN 1930-739X ; 1071-7323 ; 1930-7381
    ISSN (online) 1930-739X
    ISSN 1071-7323 ; 1930-7381
    DOI 10.1002/oby.23340
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  9. Article ; Online: Clinical Care Among Individuals with Prediabetes in Primary Care: a Retrospective Cohort Study.

    Tseng, Eva / Durkin, Nowella / Clark, Jeanne M / Maruthur, Nisa M / Marsteller, Jill A / Segal, Jodi B

    Journal of general internal medicine

    2022  Volume 37, Issue 16, Page(s) 4112–4119

    Abstract: Background: The incidence of diabetes in the general US population (6.7 per 1000 adults in 2018) has not changed significantly since 2000, suggesting that individuals with prediabetes are not connecting to evidence-based interventions.: Objective: We ...

    Abstract Background: The incidence of diabetes in the general US population (6.7 per 1000 adults in 2018) has not changed significantly since 2000, suggesting that individuals with prediabetes are not connecting to evidence-based interventions.
    Objective: We sought to describe the clinical care of individuals with prediabetes, determine patient factors associated with this care, and evaluate risk for diabetes development.
    Design: Retrospective cohort study using linked claims and electronic health record data.
    Participants: We created a cohort of adults with prediabetes based on laboratory measures. We excluded patients with a prior history of diabetes, pregnancy in prior 6 months, or recent steroid use.
    Main measures: We measured ordering and completion of clinical services targeting prediabetes management and diabetes incidence within 12 months following cohort entry. We tested the strength of the association between individuals' characteristics and outcomes of interest using bivariate and multiple logistic regression.
    Results: Our cohort included 3888 patients with a laboratory diagnosis of prediabetes (incident or prevalent prediabetes). Within 12 months, 63.4% had repeat glycemic testing, yet only 10.4% had coded diagnoses of prediabetes, 1.0% were referred for nutrition services, and 5.4% were prescribed metformin. Most patients completed labs and nutrition visits when referred and filled metformin when prescribed. Individuals with a higher glycemic level or BMI were more likely to receive prediabetes clinical care. Six percent of individuals developed diabetes within 12 months of cohort entry and had higher glycemic levels and BMI ≥ 30 kg/m
    Conclusions: Rates of prediabetes clinical care activities are low and have not improved. Strategies are urgently needed to improve prediabetes care delivery thereby preventing or delaying incident diabetes.
    MeSH term(s) Adult ; Pregnancy ; Female ; Humans ; Prediabetic State/diagnosis ; Prediabetic State/epidemiology ; Prediabetic State/therapy ; Retrospective Studies ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/therapy ; Metformin ; Cohort Studies ; Primary Health Care ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/therapy
    Chemical Substances Metformin (9100L32L2N)
    Language English
    Publishing date 2022-03-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-022-07412-9
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  10. Article ; Online: Engaging Payors and Primary Care Physicians Together in Improving Diabetes Prevention.

    Tseng, Eva / Meza, Kayla / Marsteller, Jill A / Clark, Jeanne M / Maruthur, Nisa M / Smith, Katherine

    Journal of general internal medicine

    2022  Volume 38, Issue 2, Page(s) 309–314

    Abstract: Background: Type 2 diabetes can be prevented through lifestyle programs like the Diabetes Prevention Programs (DPP), but few people with prediabetes participate in them, in part because their insurance does not reliably cover DPPs. Prior studies have ... ...

    Abstract Background: Type 2 diabetes can be prevented through lifestyle programs like the Diabetes Prevention Programs (DPP), but few people with prediabetes participate in them, in part because their insurance does not reliably cover DPPs. Prior studies have not focused on payor-level barriers.
    Objective: To understand barriers to DPP uptake that exist and intersect at different levels (patients, PCPs, and payors) to inform strategies to improve diabetes prevention in primary care settings through interviews with PCPs and payors.
    Design: From May 2020 to October 2021, we conducted remote, semi-structured interviews with PCPs and payors.
    Participants: PCPs were from primary care practices affiliated with one mid-Atlantic academic system. Payor leaders were from regional commercial, Medicare, and Medicaid plans.
    Approach: Using a standardized interview guide focused on barriers, facilitators, and potential intervention components, interviews were audio-recorded using Zoom and professionally transcribed. Two reviewers double-coded transcripts using the framework analytic approach.
    Key results: We interviewed 16 PCPs from 13 primary care clinics and 7 payor leaders representing 6 insurance plans. Two themes emerged from PCP reports of patient-level barriers: (1) lack of programs and insurance coverage of resources to address nutrition and exercise and (2) inadequate resources to address social determinants of health that impact diabetes prevention. Among barriers PCPs faced, we identified two themes: (1) low PCP knowledge about DPPs and misperceptions of insurance coverage of DPPs and (2) inadequate clinical staff to address diabetes prevention. Barriers common to PCPs and payors included (1) absence of prediabetes quality measures and (2) inadequate engagement of PCPs and patients with payors.
    Conclusions: Discussions with PCPs and payors revealed systemic barriers that suggest important priorities to improve prediabetes clinical care, including universal coverage of DPPs, clarity about coverage benefits, data reporting and outreach by payors to PCPs, and adoption of appropriate prediabetes quality measures.
    MeSH term(s) Aged ; Humans ; United States ; Diabetes Mellitus, Type 2/prevention & control ; Prediabetic State ; Physicians, Primary Care ; Primary Health Care ; Attitude of Health Personnel ; Medicare
    Language English
    Publishing date 2022-09-20
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-022-07788-8
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