From NAFLD in clinical practice to answers from guidelines

Abstract

This review of the literature consists of three sections. First, papers concerning non-alcoholic fatty liver disease (NAFLD) awareness among the general population, general practitioners, and liver and non-liver specialists were retrieved and analyzed to highlight the perception of disease, verify knowledge of current recommendations, and identify the main difficulties experienced in clinical practice. Next, position papers and clinical practice guidelines issued by International and National Hepatological Scientific Societies were identified and critically assessed in order to pinpoint the areas of convergence/difference. Finally, practical suggestions on NAFLD diagnosis and management in daily practice are provided and the open questions highlighted.

Effect of Short-Term Vitamin D Correction on Hepatic Steatosis as Quantified by Controlled Attenuation Parameter (CAP)

“…Emerging pharmacotherapies such as obeticholic acid show promise, though long-term efficacy remains unknown [8]. Thus, most recent guidelines still advocate lifestyle interventions, focusing on weight loss through diet and physical activity as treatment targets [9][10][11].…”

Exercise Training as Treatment of Nonalcoholic Fatty Liver Disease

“…Overall, the available evidence suggests that 8-12 weeks of aerobic training improves ALT and AST levels in patients with NAFLD or NASH. However, normal ALT values have been observed across the spectrum of NAFLD, and caution should be used when interpreting whether AST and ALT are appropriate surrogate markers for assessing changes in NAFLD with exercise training [33][34][35]. Additional non-invasive measurements, such as ultrasound-based techniques may provide a better method to monitor changes in liver fat when determining the efficacy of exercise on NAFLD progression [36,37].…”

Evidence based literature review of clinical management of non-alcoholic fatty liver disease in real world settings

“…15 But it has serious limitations such as sensitivity is very low when steatosis is below 30% and unable to differentiate between simple steatosis and steatohepatitis. [30][31][32] Non contrast-enhanced computerized tomography (CT) is an accurate CT technique to detect and characterize hepatic steatosis.…”

“…3 Patients with diabetes, MetS, persistently increased ALT, high necro-inflammation even with less severe disease could also be considered for pharmacotherapy to prevent disease progression. 15 Most of the current therapies are primarily directed towards improving the metabolic parameters which contribute to disease pathogenesis, such as weight loss, reducing insulin resistance and improving diabetic control. Pharmacological therapies for NAFLD and NASH usually include weight loss drugs like orlistat, insulin sensitizers such as metformin and thiazolidinediones, antioxidants such as Vitamin E and Ursodeoxycholic acid; and consideration of bariatric surgery for morbidly obese patients.…”

“…However, it is observed that specialists other than Hepatologists under appreciate the overlap between NAFLD and metabolic risk factors, thus missing a significant proportion of high-risk NAFLD patients. 15 Multiple NAFLD guidelines further increase the ambiguity on how to manage NAFLD in Indian settings. Therefore, the objective of the present review is to understand the gap between real world clinical practices, guidelines recommendations and to propose minimum essentials that can be followed in clinical practice in India.…”