Diagnosis and Management of Nonalcoholic Fatty Liver Disease

Abstract

Nonalcoholic fatty liver disease affects about 25% of the adult population globally and is strongly associated with metabolic syndrome, affecting most patients who have dyslipidemia, obesity, or type 2 diabetes . 1 About 2% to 7% of those with NAFLD have evidence of NASH on liver biopsy with hepatic inflammation and injury. 2 Long-standing NAFLD and NASH can result in cirrhosis and its complications, including hepatocellular carcinoma. Currently, NASH ranks as the second most common reason for liver transplant in the United States and will likely surpass hepatitis C in the coming years as the most common. A diagnosis of NAFLD requires evidence of hepatic steatosis (on imaging or histology) in the absence of secondary causes of steatosis or other liver disease, such as excessive alcohol intake, hepatitis C, Wilson disease, and hepatotoxic medications. Methods to noninvasively assess for advanced fibrosis (bridging fibrosis or cirrhosis) are evolving and can help target which patients should receive a liver biopsy and, potentially, pharmacologic therapy.

Systematic review and meta-analysis of Roux-en-Y gastric bypass against laparoscopic sleeve gastrectomy for amelioration of NAFLD using four criteria

“…Overall, bariatric surgery lowers the incidence of obesityrelated co-morbidities compared with medical management [9][10][11][12][13][14]. Yet, randomized control trials comparing LSG with RYGB for NAFLD outcomes are greatly needed, with very few reported [15].…”

Associations Between Body Fat, Muscle Mass, and Nonalcoholic Fatty Liver Disease: A Population‐Based Study

“…Nonalcoholic fatty liver disease (NAFLD) affects about 15%‐30% of the world population and encompasses a spectrum of histologic liver changes, ranging from simple steatosis to nonalcoholic steatohepatitis, fibrosis, cirrhosis, and liver cancer . In addition to being one of the most common forms of liver disease worldwide, NAFLD is also a risk factor for several other chronic diseases, including chronic kidney disease, cardiovascular disease, and osteoporosis .…”

Abstracts

“…If significant fibrosis cannot be ruled out, diabetologists should refer diabetic patients to a hepatologist. The AASLD guidelines recommend against population screening, noting poor evidence for longer‐term benefits and cost‐effectiveness 1 while recent EASL–EASD–EASO clinical practice guidelines recommend screening for NAFLD in people with T2DM 2 . In these recommendations, the presence of NAFLD should be looked for irrespective of liver enzyme levels, since people with T2DM are at high risk of disease progression.…”

“…Lifestyle changes remain the cornerstone of therapy. A systematic review of studies assessing liver outcomes supported reduction of daily caloric intake in combination with 30‐60 minutes of exercise 3‐5 days per week 1 . Regarding treatment for NAFLD, the AASLD advises pioglitazone in patients with biopsy‐proven NASH with and without type 2 diabetes, and vitamin E in only patients without diabetes and with biopsy‐proven NASH without cirrhosis 1 Jean Michel Petit Université de Bourgogne, Centre de Recherche INSERM LNC‐UMR 1231, Services de diabétologie et endocrinologie, Dijon.…”