brand logo

Nonalcoholic fatty liver disease (NAFLD) describes a spectrum of fatty infiltration, inflammation, and fibrosis of the liver caused by metabolic factors. It is projected to become the leading cause of cirrhosis and need for liver transplantation in the United States. Guidelines from the American Association for the Study of Liver Diseases (AASLD) do not recommend routine screening of patients at high risk of NAFLD. European guidelines recommend testing for certain high-risk patients. Hepatic steatosis and nonalcoholic steatohepatitis (NASH) are difficult to diagnose and often go unrecognized until patients have advanced fibrosis or cirrhosis. Noninvasive methods are used to assess fibrosis, such as fibrosis scores and vibration-controlled transient elastography. Liver biopsy remains the reference standard for NASH diagnosis and fibrosis staging. The mainstays of treatment for NAFLD, NASH, and fibrosis are weight loss and a healthy diet. Currently, no drugs have been approved by the Food and Drug Administration (FDA) for management of these conditions. Drugs for diabetes management (eg, glucagon-like peptide 1 receptor agonists, pioglitazone) can be useful in patients with diabetes and NASH. Among patients with NAFLD, cardiovascular disease is a common cause of mortality. Thus, the AASLD guidelines recommend consideration of omega-3 fatty acids for hypertriglyceridemia management in patients with NAFLD, and statins for hyperlipidemia management in most patients with NAFLD and NASH.

Case 3. WR is a 58-year-old woman with a history of prediabetes, hypertension, hyperlipidemia, and obesity. A comprehensive metabolic panel obtained before she started statin therapy shows an alanine aminotransferase (ALT) level of 48 U/L. The upper limit of normal for ALT at this laboratory is 35 U/L.

Nonalcoholic fatty liver disease (NAFLD) describes a spectrum of fatty infiltration, inflammation, and fibrosis of the liver caused by metabolic rather than toxic or infectious factors.10 Risk factors include features of metabolic syndrome, such as hypertension, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, impaired glucose metabolism, and central obesity.

Nonalcoholic fatty liver disease is projected to become the leading cause of cirrhosis and need for liver transplantation in the United States.52 In 2015, the global prevalence of NAFLD in adults was estimated conservatively at 25.24%.53 Sixty-six percent of patients older than 50 years with diabetes or obesity are thought to have nonalcoholic steatohepatitis (NASH) with advanced fibrosis.54 The number of patients with NAFLD who also have NASH and fibrosis likely will increase, as well as the number of risk factors per patient.55

Already a subscriber?  Log In

Subscribe

From $335
  • Immediate, unlimited access to all FP Essentials content
  • 60 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Edition Access

$59
  • Immediate, unlimited access to this edition's content
  • 5 CME credits
  • AAFP app access
  • Print delivery available
Interested in AAFP membership? Learn more  Learn More

Continue Reading

Copyright © 2021 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.