2017-07-26 20:41:15 UTC

Talking to Patients With NAFLD

July 27, 2017

Five steps to help you approach patients that have non-alcoholic fatty liver disease (NAFLD).

Talking to Patients with NAFLD

A recent article in Gastroenterology, “How to Approach a Patient with Non-Alcoholic Fatty Liver Disease,” by Herbert Tilg, MD, discussed approaches to diagnosis, treatment and follow-up for patients with non-alcoholic fatty liver disease (NAFLD). NAFLD, which is the most common liver disease world-wide, covers a spectrum ranging from mild steatosis (buildup of fat in the liver) to more severe cases, including non-alcoholic steatohepatitis (NASH). Here are some of the major takeaways from the article and some key points to highlight when talking to patients with NAFLD.

Understanding NAFLD

NAFLD is usually found in patients who are obese, may or may not have type 2 diabetes, have unhealthy diets and lack physical activity or exercise. An official diagnosis is important to help indicate the long-term prognosis, which could eventually lead to liver transplantation or other complications. There are several ways to assess if a patient has NAFLD. Ultrasonography is usually the preferred procedure to diagnose NAFLD, because it is widely available and cheaper than an MRI, but ultrasound-based controlled attenuation parameter (CAP) is also sometimes recommended. 

Adequately assessing fibrosis is considered the most important part of managing NAFLD patients, as many studies have shown that fibrosis is the key factor in determining long-term risk for developing liver complications, such as cirrhosis and hepatocellular carcinoma (HCC) . Transient elastography (TE) is the most commonly used technique for monitoring fibrosis, and biomarkers/scores are also useful. MR-based assessments are usually considered the most accurate, but are often unavailable or not feasible due to financial limits.

When talking to patients:

  1. Educate the patient on what NAFLD is and what it means for their future health. A diagnosis of NAFLD means they will be at a higher risk for further liver complications, including chronic liver disease, liver cirrhosis and HCC (liver cancer). Because NAFLD is often associated with insulin resistance, prepare the patient for the likelihood of a life-long search for potential cardiovascular diseases, type 2 diabetes and chronic kidney disease.
  2. Recommend that the newly diagnosed NAFLD patient try lifestyle changes focusing on exercise. Weight loss and moderate to vigorously moderate exercise, such as brisk walking or jogging, have been shown to improve NAFLD. While a healthy diet is always recommended, there is not much evidence to prove that any specific diets can improve liver disease. 
  3. Discuss possible treatment options that fit your patients’ unique needs. Although there are currently no approved pharmacological therapies for NAFLD, there are some treatments that could be used for high-risk NASH patients. Studies have found histological improvement in high-risk patients with NASH who received medicines such as pioglitazone, as well as patients who received vitamin E; however, there is some concern about side effects and long-term safety.
  4. Consider the patient in a holistic manner. It’s important to search for co-morbidities, including arterial hypertension, diabetes and sleep apnea.
  5. Open the lines of communication, so your patients are comfortable asking questions and taking part in all the decisions involved in care. 

 

More on Non-Alcoholic Fatty Liver Disease (NAFLD)

Blog: Special 15th Anniversary Collection from Clinical Gastroenterology and Hepatology

Oct. 11, 2017

Celebrate this milestone with a look back at landmark articles, commentaries and reviews. Read more on the AGA Journals blog.

Blog: Restricting Fructose to Reduce Fatty Liver Disease

Sept. 19, 2017

Researchers report that reducing dietary fructose decreases liver fat in children with obesity and metabolic syndrome. Read more in the AGA Journals blog.

Agreement Between Magnetic Resonance Imaging Proton Density Fat Fraction Measurements and Pathologist-Assigned Steatosis Grades of Liver Biopsies From Adults With Nonalcoholic Steatohepatitis

Sept. 1, 2017

PDFF estimated by MRI scanners of different field strength and at different sites, accurately classifies grades and changes in hepatic steatosis when histologic analysis of biopsies is used as a reference.