MANAGEMENT OF ENDOCRINE DISEASE: Non-alcoholic fatty liver disease: a multidisciplinary approach towards a cardiometabolic liver disease

Abstract

<jats:p>Non-alcoholic fatty liver disease (NAFLD) is a growing health problem with a global prevalence of over 25% and prevalence rates of over 60% in high risk populations. It is considered the hepatic component of the metabolic syndrome and is associated with an increased risk of the development of various liver-associated and cardiometabolic complications. Given the complexity of NAFLD and associated comorbidities and complications, treatment requires interventions from a variety of different healthcare specialties. However, many clinicians are currently insufficiently aware of the potential harm and severity of NAFLD and associated comorbidities, complications and the steps that should be taken when NAFLD is suspected. Recognizing which patients suffer from non-progressive simple steatosis, metabolically active NASH with high risk of developing cardiovascular disease and which patients have a high risk of developing cirrhosis and hepatocellular carcinoma is important. Unfortunately, this can be difficult and guidelines towards the optimal diagnostic and therapeutic approach are ambivalent. </jats:p> <jats:p>Here we review the pathogenesis, diagnostics and treatment of NAFLD and discuss how multidisciplinary care path development could move forward. </jats:p>

Referral care paths for non‐alcoholic fatty liver disease—Gearing up for an ever more prevalent and severe liver disease

“… 6 Patients with liver cirrhosis are at high risk for liver decompensation and HCC. 7 According to a meta‐analytic assessment, the annual incidence of HCC in NAFLD patients is 0.44 per 1000 person‐years. 2 …”

A Review of the Epidemiology, Pathophysiology, and Efficacy of Anti-diabetic Drugs Used in the Treatment of Nonalcoholic Fatty Liver Disease

“…As NAFLD is a component of the metabolic syndrome, and as such, a multisystem disorder, there is agreement that management of NAFLD should involve a multidisciplinary approach. Such an interdisciplinary team would likely consist of hepatologists, diabetologists, cardiologists, and nutritional doctors, as well as dietitians, exercise physiologists, and psychologists [ 29 , 30 ]. Indeed, studies comparing models of care (i.e., care provided by a multidisciplinary team versus single providers) in patients with heart failure have consistently demonstrated superior outcomes using a multidisciplinary approach, including a reduction of cardiovascular risk [ 29 , 30 ].…”

“…Such an interdisciplinary team would likely consist of hepatologists, diabetologists, cardiologists, and nutritional doctors, as well as dietitians, exercise physiologists, and psychologists [ 29 , 30 ]. Indeed, studies comparing models of care (i.e., care provided by a multidisciplinary team versus single providers) in patients with heart failure have consistently demonstrated superior outcomes using a multidisciplinary approach, including a reduction of cardiovascular risk [ 29 , 30 ]. The high prevalence of NAFLD, however, makes it costly and impractical to provide such multidisciplinary service for all patients and at all levels of service provision.…”

Diabetic Kidney Disease, Cardiovascular Disease and Non-Alcoholic Fatty Liver Disease: A New Triumvirate?

“…Nonalcoholic fatty liver disease (NAFLD) is a liver condition defined as the accumulation of intracellular fat in hepatocytes in the absence of excessive alcohol intake, certain metabolic diseases or pharmacological treatment [ 1 , 2 ]. Although NAFLD is considered the liver component of the metabolic syndrome (MS), progression to liver fibrosis has been associated with type 2 diabetes mellitus (T2D) [ 3 ], cardiovascular disease (CVD) [ 4 ], chronic kidney disease (CKD) [ 5 ] and other comorbidities.…”