Perspectives

Know Your Guidelines Series: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings

Authors: Desiree C. Burroughs-Ray, MD, MPH, Samantha Whitwell, MD, Nathan Williams, BA, Hira Imran, MD, Christopher D. Jackson, MD

Abstract

Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of liver disease without ongoing or significant alcohol use that ranges from hepatic steatosis to cirrhosis. NAFLD is associated with obesity, insulin resistance, type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia.1,2 Nonalcoholic steatohepatitis (NASH) represents the progression of NAFLD with at least 5% of hepatic steatosis paired with inflammation and liver damage. NASH is among the top causes of hepatocellular carcinoma and the second leading reason for liver transplantation. Despite the increased mortality associated with all NAFLD stages, the literature suggests that clinicians have knowledge gaps regarding NAFLD and its predominance in patients with T2DM. Primary care physicians can improve the diagnosis and treatment of NAFLD and identify patients who are at increased risk.
Posted in: Endocrinology, Diabetes, and Metabolism40

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References

1. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73–84.
 
2. Younossi ZM, Loomba R, Anstee QM, et al. Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. Hepatology 2018;68:349–360.
 
3. Younossi Z, Stepanova M, Ong JP, et al. Nonalcoholic steatohepatitis is the fastest growing cause of hepatocellular carcinoma in liver transplant candidates. Clin Gastroenterol Hepatol 2019;17:748–755.e3.
 
4. Simon TG, Roelstraete B, Khalili H, et al. Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut 2021; 70:1375–1382.
 
5. Lomonaco R, Godinez Leiva E, Bril F, et al. (). Advanced liver fibrosis is common in patients with type 2 diabetes followed in the outpatient setting: the need for systematic screening. Diabetes Care 2021;44:399–406.
 
6. Siddiqui MS, Yamada G, Vuppalanchi R, et al. Diagnostic accuracy of noninvasive fibrosis models to detect change in fibrosis stage. Clin Gastroenterol Hepatol 2019; 17:1877–1885.
 
7. Haigh L, Kirk C, El Gendy K, et al. The effectiveness and acceptability of Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis. Clin Nutr 2022;41:1913–1931.
 
8. Cusi K, Orsak B, Bril F, et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. Ann Intern Med 2016;165:305–315.
 
9. Sangro P, de la Torre Aláez M, Sangro B, et al. Metabolic dysfunction–associated fatty liver disease (MAFLD): an update of the recent advances in pharmacological treatment. J Physiol Biochem 2023;79:869–879.