Description
NAFLD is a common liver condition characterized by fat accumulation in hepatocytes without significant alcohol intake. Diagnosis is primarily based on clinical history, elevated liver enzymes, and imaging, particularly ultrasound. Liver biopsy remains the gold standard for assessing severity and fibrosis. Management focuses on lifestyle modifications, including weight loss through diet and exercise, which can reduce hepatic steatosis and improve liver function. Pharmacologic treatments, such as vitamin E or pioglitazone, may be considered in selected cases, particularly non-alcoholic steatohepatitis (NASH). Regular monitoring and managing associated metabolic conditions like diabetes, obesity, and dyslipidemia are key to long-term management.
Summary Listen
- Fatty liver disease is a growing concern in India, with prevalence reaching 40% in adults and 35% in children. Urban areas have a higher prevalence, and it affects both males and females equally. The diagnosis involves detecting fatty liver via ultrasound, biopsy, or moralistography, alongside conditions like diabetes, obesity, or at least two metabolic risk factors (waist circumference, blood pressure, dyslipidemia, prediabetes, elevated HOMA-IR, or high hsCRP).
- The progression of fatty liver involves stages from steatosis to inflammation, leading to fibrosis, and eventually cirrhosis. NASH progresses to cirrhosis at a rate of 4-25% per annum, and cirrhosis to decompensation carries a 25% risk in 8-10 years. Notably, NASH can lead to hepatocellular carcinoma (HCC) even without cirrhosis.
- Staging fibrosis is crucial for prognosis and treatment. Patients are categorized as low-risk or at-risk (F2 fibrosis or higher), with the latter targeted for amokotaripi. When fibrosis scans aren't available, scores like APRI, FIB-4, and NFS can estimate fibrosis. Liver biopsy remains the gold standard for diagnosis and staging.
- Risk stratification involves screening individuals with obesity, type 2 diabetes, or metabolic syndrome for fatty liver via ultrasound. Other causes of fatty liver, like alcohol consumption, viral infections, TPN, malnutrition, and certain drugs, should be excluded.
- The cornerstone of management involves diet and lifestyle changes, including calorie restriction, increased exercise, and weight reduction. Target weight loss is >10% for significant fibrosis and >7% for steatohepatitis without fibrosis. Calorie restriction (30% or 500-1000 kcal/day) is crucial. Coffee consumption (2-3 cups daily) may have a positive impact.
- Both aerobic and resistance exercise are beneficial, with moderate-intensity exercise recommended for at least 200 minutes per week. Pharmacotherapy is considered for patients with significant fibrosis (F2 or higher). Medications include vitamin E, saroglitazar, and omega-3 fatty acids.
- Saroglitazar, a PPAR alpha gamma agonist, can improve transaminases, hepatic steatosis, insulin resistance, and dyslipidemia. Bariatric surgery or endoscopic intragastric balloon placement can be considered for weight loss in appropriate candidates. Research is ongoing for new drugs targeting various pathways involved in fatty liver disease.
Sample Certificate
About the Speakers
Comments
Comments
You must be logged in to leave a comment.