MAFLD – who and how should we screen?

13th February 2023, Dr Chee L Khoo

Steatosis

Now that I know how common metabolic-dysfunction associated fatty liver disease (MAFLD) is especially amongst those patients with elements of metabolic syndrome, it’s hard not to assume that every second patient have MAFLD. We also know that not all MAFLD has abnormal liver function tests (LFTs). So, if you only suspect or screen only those with abnormal LFts, then you are going to miss many MAFLD.…

NAFLD vs MAFLD – what’s in a name?

4th January 2023, Dr Chee L Khoo

steatosis

The term non-alcoholic fatty liver disease (NAFLD) was first coined by Ludwig in 1980. It was rather an exclusive diagnostic term to exclude the other liver disease from being included in the definition. If your liver disease relates to excessive alcohol intake, drugs or autoimmune conditions, it cannot be included in the diagnosis.…

Omega-3 supplements – a fishy tale just got more fishy

14th November 2022, Dr Chee L Khoo

fish oil supplements

We all have patients with high triglycerides (TG) that warrant intensification of our lipid lowering treatment. Statins are efficacious in reducing total cholesterol (TC), increasing high density lipoprotein cholesterol (HDL-C) and reducing low density lipoprotein cholesterol (LDL-C). Statins also reduce triglycerides levels but often these patients have residual hypertriglyceridaemia that warrants the addition of a fibrate to get our TG to target.…

Point-of-care testing – how does that fit into primary care?

POCT

28th October 2022, Dr Chee L Khoo

Point-of-Care Testing (POCT) is defined as laboratory testing conducted close to the site of patient care, typically by clinical personnel whose primary training is not in the clinical laboratory sciences, or by patients (self-testing). In theory, POCT which produce results within minutes can assist in management of a number of chronic diseases. It could be useful in patients whose adherence to appointments is often an issue or in patients who are time poor and would prefer to attend the practice as infrequently as possible.…

Lipoprotein (a) – should we routinely measure in everyone?

28th August 2022, Dr Chee L Khoo

Atherosclerosis

We know that low density lipoprotein cholesterol (LDL-C) is a risk factor for atherosclerotic cardiovascular disease (ASCVD). We also know that reducing LDL-C levels can significantly reduce those risks irrespective of whether they have established cardiovascular disease or not (1). That means reducing LDL-C works in secondary as well as primary prevention. However, even when LDL-C is well-controlled in statin-treated ASCVD patients, there is still a residual risk of cardiovascular disease.…

Type 3c Diabetes – diabetes of exocrine pancreas

12th August 2022, Dr Chee L Khoo

We used to think of the islets of Langerhans as tenants in the exocrine pancreas boarding house. Like two separate cell types living under the same roof – one endocrine and the other exocrine. Both cell types happen to be involved in the business of nutrient digestion but they perform totally separate functions. Patients with diabetes are more likely to get pancreatic cancers and pancreatic exocrine insufficiency.…

SURMOUNT-1: Tirzepatide for obesity management

29th July 2022, Dr Chee L Khoo

12 months ago, at GPVoice, we announced the arrival of drug LY3298176, which now has a name, tirzepatide, as the first in its class of “twincretins” in the management of type 2 diabetes. We briefly explored the 4 Phase 3 trials looking at the efficacy and safety of trizepatide in comparison with placebo, semaglutide, insulin degludec and insulin glargine.…

Fenofibrate and retinopathy – when should we use it?

13th June 2022, Dr Chee L Khoo

retinopathy

Fenofibrate is a commonly-used lipid lowering agent. In particular, it is recommended for patients with high triglycerides. Two previous studies have demonstrated that fenofibrate reduces the progression of diabetic retinopathy (DR) in patients who already have DR. Despite the benefits of fenofibrate, we don’t see recommendations for its use featured prominently in guidelines.…

NAFLD – the many treatment options in the pipeline

12th June 2022, Dr Chee L Khoo

NAFLD

Non-alcoholic fatty liver disease (NAFLD) is the most common liver condition in the western world. A significant proportion of these patients developed inflammation and progressed to non-alcoholic steato-hepatitis (NASH). Further and persistent inflammation can lead to cirrhosis and ultimately, to liver failure or liver cancer. Management till recently is primarily targeted towards lifestyle measures to reduce liver fat.…

CV disease and inflammation – where do the cells come from?

22nd May 2022, Dr Chee L Khoo

The close association of inflammation and cardiovascular disease is well known for some time. Inflammation is an essential mediator of all stages of atherosclerosis, from initiation to progression and the development of thrombotic complications (1,2). Circulating immune cells play a critical role in the build-up of atherosclerotic plaques by adhering to activated endothelium and infiltrating the arterial wall to become lesional cells (3).…

Obese yet skinny? – triple trouble

12th December 2021, Dr Chee L Khoo

old and weak or weak and old?

We touched on the subject of osteosarcopenia on a number of occasions over the years. These are people who have weak bones and have lost muscles. These are often older patients that have become weak for various reasons. Aging reduces the quality and strength of bones and muscles and increases body fat, which lead to the simultaneous occurrence of sarcopenia, osteopenia, and adiposity.…

Dyslipidaemia in the young – who should we suspect?

24th October 2021, Dr Chee L Khoo

Last fortnight we explored the disease burden in patients who have high lipids from a very young age and the effect on their future cardiovascular risk. This consideration allows us to think about who should be aggressively treated and whom we can just safely watch, at least for a few years. It would be nice to be able identify who we should screen for high lipids from a young age so that we can start lifestyle measures early.…