For Albert Do, MD, MPH, ABOM, his training in gastroenterology, hepatology, and obesity medicine coincide into one key area of study: fatty liver disease.
“Fatty liver disease occurs when excess fat develops inside the liver, which can lead to inflammation and in some fibrosis or scarring,” said Do, assistant professor of medicine (digestive diseases); and clinical director, Fatty Liver Disease Program.
In his role as Clinical Director of the Fatty Liver Disease Program at Yale, Do has helped the program expand its reach and embrace the interdisciplinary nature of fatty liver disease. “The goal was originally to focus on metabolic fatty liver disease, which is due to excess weight and obesity,” said Do. “We have since expanded that definition to include all types of fatty liver diseases, such as alcoholic fatty liver disease and secondary fatty liver diseases. These can be from medication, certain diseases of pregnancy, and certain genetic disorders. Extricating what the specific cause is and treating that cause of fatty liver disease has been very interesting, and it has led to a lot of organic program growth."
Do was inspired to go into medicine after witnessing the health disparities in his hometown. “My parents were refugees, and they came to the United States due to the Vietnam War,” said Do. “I saw how health-related challenges affected the livelihoods of those around me.”
As Do struggled personally with obesity, he became interested in treating metabolic-related diseases. “Fatty liver disease has become the most interesting one for me, in that it melds the physiology of liver disease with the public health importance of treating metabolic diseases, obesity and unhealthy alcohol use, which is another factor that causes fatty liver disease. So my work allows me to not only care for patients by helping them with weight loss, but also identify patients who have alcohol use that is causing them harm and help them get treated for that too,” said Do.
Do says expanding the Fatty Liver Disease Program has pushed him to grow his skill set and put to use his internal medicine training. “Being able to use that skill set again and thinking about the patient as a whole is very exciting,” said Do. “Talking to a wide variety of providers and other sub-specialists and being able to play a small role in all of their fields myself is probably the most exciting part.”
Do is currently building the program’s patient registry to evaluate treatment efficacy. “We measure that efficacy in terms of helping patients to achieve weight loss, while also looking at other parameters like cholesterol and diabetes,” said Do.
His work also includes identifying patients for more advanced therapies. “Part of my prerogative is to identify patients who would be at risk for progressive disease and to link them to clinical trials, given that we are at Yale and at the forefront of many diseases, including this one,” said Do. “There are no approved medications by the Food and Drug Administration that have been found to clearly improve fatty liver disease. So for patients who need more intensive treatment, clinical trials are a great option. There are many drugs in phase II studies, and a few in phase III of which Yale is one of several clinical sites.”
As Do continues his work, one of his top priorities is collaborating with colleagues throughout internal medicine to identify fatty liver disease in patients before it becomes severe. “By virtue of the size of internal medicine, some of my own colleagues in gastroenterology are not fully aware of what I do,” said Do. “And even taking one more step back, the most common cause of death from fatty liver disease is actually cardiovascular disease. So other collaborations that I am working on are with our cardiovascular colleagues. I would like to develop closer collaborations with cardiology, especially in identifying cardiologists interested in lipids disorders.” Do adds that there are also a variety of genetic diseases related to cholesterol metabolism that place patients at risk for fatty liver disease. “So again, that's a close link to our translational research colleagues, and there are a few physicians in my section who helped me conduct advanced genetic testing on patients who may have a genetic component to their fatty liver disease.”
Throughout all of this, Do continues to return to the question of healthcare access. “Thankfully at Yale, we have the Project Access Program, which helps to link patients to subspecialty care,” said Do. “But I recognize that because I am a subspecialist, there are many people who will never make their way to me. And that's a ripe opportunity for there to be better equity and programming policy developed. Personally, over the years I have been developing my skill set so that no matter what kind of time a patient has to work on weight loss, what kind of money one has to invest, what kind of insurance one has, there's at least one trick I have up my sleeve that can help. So that's something that I'm building in the course of my practice.”
Since forming one of the nation’s first sections of hepatology and then gastroenterology over 50 years ago, Yale’s Section of Digestive Diseases has had an enduring impact on research and clinical care in gastrointestinal and liver disorders. To learn more about their work, visit Digestive Diseases.