Management and diagnosis of fatty liver disease

Abstract

Nonalcoholic fatty liver disease is a common cause of chronic liver disease and has been an increasingly studied topic of research as the obesity epidemic has been growing. There is a significant morbidity and mortality with uncontrolled steatohepatitis, which can progress to fibrosis, cirrhosis and hepatocellular carcinoma. The prevalence of this disease has been estimated to be roughly one-third of the western population, thought to be largely due to diet and sedentary lifestyle. Several treatments have been studied including vitamin E, insulin-sensitizing agents and ursodeoxycholic acid; however, the only treatment shown to improve the histologic changes of nonalcoholic fatty liver disease is weight loss. Given the proven benefit of weight loss, there may be reason to screen at-risk populations; however, limited availability of other disease-modifying treatments may limit the cost-benefit ratios. A better understanding of the diagnosis and management of this condition is required to alter the course of this modifiable disease.

Analogy between non-alcoholic steatohepatitis (NASH) and hypertension: a stepwise patient-tailored approach for NASH treatment

“…and secondary HTN are less common. NAFLD is one of the main causes of chronic liver disease globally [ 7 ]. A recent study determined that the prevalence of NAFLD was 24% and that the global prevalence positively correlated with the gross national income per capita: Europe observed a higher prevalence (28%) than the Middle East (12%) and East Asia (19%) [ 8 ].…”

“… Guidelines for non-pharmacological management are fundamental in the treatment of HTN. Weight reduction, reduced salt intake, increased dietary intake of fresh fruits and vegetables, increased low-fat dairy intake, physical activity and a reduction in saturated fat and cholesterol intake, along with regular fish intake are recommended for a healthy lifestyle change [ 7 ]. Most studies and recommendations suggest an association between salt intake and HTN, in which decreased salt intake has been proven to be effective in decreasing HTN over the years.…”

Role of bariatric surgery in treatment of non-alcoholic fatty liver disease

“…47,55,62,79,80 Selection of bariatric surgery procedure must be done based on other conditions and indications and also need to have regular and punctual follow up after surgery. 81 In confirmed NAFLD or patients that are at risk of advanced NAFLD, as possible, must avoid of malabsorptive procedures such as BPD/DS due to rapid and severe weight loss that result in FFA rapid releasing and transfer of long chain fatty acids to liver and bacterial over growth that can lead to worsening of NAFLD.…”

Nonalcoholic fatty liver disease – current status and future directions

“…A detailed discussion of all known or upcoming treatments is beyond the scope of this review and has been extensively reviewed elsewhere. 14,18,115,167…”