NAFLD (PDF)

NAFLD Ahmed Othman Abodooh , MD Lecturer of Internal Medicine (GIT) Internal medicine department Faculty of Medicine Sohag University Non Alcoholoc Fatty Liver (NAFLD) Definition Non-alcoholic fatty liver disease (NAFLD) includes non-alcoholic fatty liver (NAFL) and...

NAFLD Ahmed Othman Abodooh , MD Lecturer of Internal Medicine (GIT) Internal medicine department Faculty of Medicine Sohag University Non Alcoholoc Fatty Liver (NAFLD) Definition Non-alcoholic fatty liver disease (NAFLD) includes non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). NAFL: hepatic steatosis (Excess fat accumulation in the liver >5%) without inflammation, in the absence of known causes of liver steatosis Cuases of hepatic steatosis Alcohol: The threshold for alcohol intake is defined as consumption of > 21 drinks/week in men and > 14 drinks/week in women. One standard drink contains 14 grams of pure alcohol. Hepatitis C TPN Short bowel syndrome Rapid weight loss Prevalence NAFL affects ~30% of US adults. NASH affects ~ (1.5%-6.5%) of US adults.  Risk Factors Older age, DM Dyslipidemia, Obesity Metabolic syndrome Hispanic/Latinx ethnicity, Polycystic ovary. Metabolic Syndrome Pathophysiology Prognosis Diagnosis and workup Fatty liver can be seen on ultrasound (bright liver), CT, and MRI. Exclude other causes of liver diseases (viral, autoimmune, hemochromatosis, etc.) Test for risk factors for NASH such as diabetes and dyslipidemia. Measure BMI.  Methods to assess fibrosis: Laboratory tests Fibrosis scoring: These non-invasive scoring systems are based on several lab values, and predict the level of fibrosis in patients with NAFLD such as: NAFLD fibrosis score (NFS). NAFLD Fibrosis-4 score (FIB-4). Fibrosure® test measures several biomarkers (ALT, Bilirubin, total GGT, α2-macroglobulin,Apolipoprotein A1, , Haptoglobin) to provide an estimate of fibrosis stage Methods to assess fibrosis: Vibration Controlled Transient Elastography (Fibroscan®):. Methods to assess fibrosis: Magnetic resonance elastography (MRE): Methods to assess fibrosis: Liver biopsy is the gold standard for diagnosis. (Findings include steatosis, necroinflammation, ballooning hepatocytes, Mallory bodies, and fibrosis). Methods to assess fibrosis: Indications for liver biopsy : Patients with the metabolic syndrome. Patients with high NAFLD fibrosis score (NFS or FIB-4). Patients with high liver stiffness measured by transient elastography or MRE Patients in whom liver biopsy is needed to exclude other etiologies of liver disease.  Management Treatment of metabolic syndrome. Treating cardiovascular risk factors. The most common cause of death in NAFLD is cardiovascular disease. Statins are safe to use to treat dyslipidemia. Avoid statins in decompensated cirrhosis.  Management Hypocaloric diet. Smoking cessation. Regular exercise (150 minutes per week; or ≥5 exercise sessions per week, with each session of ≥10 minutes in duration)  Management Weight loss: A weight loss of 5% can improve steatosis, steatohepatitis, while 10% weight loss can reverse fibrosis  Management Insulin sensitizers - Metformin did not show a major benefit on liver histology in randomized controlled trials. It is not recommended for the treatment of NASH.  Management Insulin sensitizers Pioglitazone: can be used to treat biopsy-proven steatohepatitis in diabetic patients.  Management Vitamin E (α-tocopherol): vitamin E at 800 IU/day is recommended for nondiabetic, biopsy-proven NASH. THANK OU