Management of NAFLD patients with advanced fibrosis

Abstract

The prevalence of non alcoholic fatty liver disease (NAFLD) has increased to 25% in the general population and could double by 2030. Liver fibrosis is the main indicator of morbidity and mortality and recent estimations suggest a substantial number of individuals with undiagnosed advanced liver disease. Strategies to monitor advanced fibrosis are essential for early detection, referral, diagnosis and treatment in primary care and endocrine units, where NAFLD and consequently liver fibrosis are more prevalent. Blood‐based non‐invasive methods could be used to stratify patients according to the risk of the progression of fibrosis and combined with imaging techniques to improve stratification. Powerful new diagnostic tools such as MRE and PDFF are emerging and might prevent the need for liver biopsy in the near future. The current therapeutic landscape of NAFLD is rapidly evolving with an increasing number of molecules that treat key factors involved in its progression, but that still have a limited or no ability to effectively reverse fibrosis. Management of this disease will probably require a combination of sequential and personalized treatments as a result of its complex and dynamic pathophysiology. Lifestyle interventions are still the most effective therapeutic option and should be better integrated into patient management together with specific programs of bariatric endoscopy/surgery for morbidly obese patients.

Aurantio-Obtusin Attenuates Non-Alcoholic Fatty Liver Disease Through AMPK-Mediated Autophagy and Fatty Acid Oxidation Pathways

“…NAFLD affects about 20–30% of the adult population in developed countries and is inevitably becoming the next major health epidemic ( Maya-Miles et al, 2021 ; Wegermann et al, 2021 ). Although a variety of therapeutic drugs curing NAFLD has been proposed, almost all of them have failed in the clinical trial, leading to an urgent requirement of novel therapeutic options.…”

Screening strategy for non-alcoholic fatty liver disease

“…Once FIB-4 yields intermediate or high results, second-line VCTE can be used to improve the identification of advanced fibrosis, which has been shown to reduce the need for liver biopsy [ 131 , 132 ]. Patients can then undergo VCTE when advanced fibrosis cannot be excluded [ 133 ]. The cut-off for advanced fibrosis with VCTE is 8.0 kPa (M probe) or 6.2 kPa (XL probe) for the exclusion of advanced fibrosis.…”

Non-alcoholic fatty liver disease: An emerging epidemic of global importance

“…The treatment of NAFLD depends on the severity and stage of the disease, as well as on any underlying medical conditions. [138][139][140][141][142][143][144][145][146][147][148][149][150][151][152][153][154][155][156][157] For patients with mild to moderate NAFLD, lifestyle changes such as weight loss, a healthy diet, and regular exercise may be recommended. These changes can improve liver health, reduce inflammation and fat accumulation in the liver, and prevent the progression of the disease.…”