Nonalcoholic fatty liver disease (NAFLD)

• General Measures: Apply to nonalcoholic fatty liver disease (NAFLD) patients.

• Vaccinations: Hepatitis A and B vaccination for non-immune patients.

• Immunizations: Standard age-appropriate immunizations.

• Hyperlipidemia: Lipid-lowering therapy for patients with hyperlipidemia.

• Diabetes: Optimize blood glucose control for diabetic patients.

• Weight Management: Recommend weight loss for obesity, 5-7% body weight via lifestyle changes.

• Alcohol Avoidance: Refrain from heavy alcohol use, suggest abstinence.

• Medical Therapy:

  • NASH without Diabetes: Suggest vitamin E (800 IU/day) for NASH patients without diabetes.
  • NASH with Diabetes: Choose glucose-lowering therapy based on NASH presence.
  • Options: Consider
    • pioglitazone,
    • GLP-1 receptor agonists.

• Lab Monitoring: Check aminotransferases post-weight loss, evaluate abnormal levels.

• Fibrosis Monitoring: Noninvasive fibrosis assessment based on weight loss and aminotransferase levels.

  • Assessment Interval: 3 years if weight loss not achieved, 4 years if weight loss achieved. (JAMA 2020;323:1175; Lancet 2021;397:2212)

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• Definition: fatty infiltration of liver + absence of EtOH or other cause of steatosis (HCV, etc.) NAFL = steatosis, Ø inflam; NASH = steatosis + inflam ± fibrosis on bx
• NAFLD: 25% of U.S. pop. & over 60% in T2DM & obesity
• NASH: 2–5% of NAFLD & risk of cirrhosis in NASH w/ fibrosis on bx is 30% at 10 y
• Clinical: 80% asx, ↑ ALT > AST, but nl ALT/AST does not exclude poss. of NASH on bx
• Dx: liver bx remains gold standard. VCT elastography emerging alternative (J Hepatol 2017;66:1022). FIB-4/NAFLD fibrosis score predicts NASH w/ advanced fibrosis w/ PPV >80%.

Treatment-Nonalcoholic fatty liver disease (NAFLD)