How Should We Manage Patients With Non-alcoholic Fatty Liver Disease in 2007?

Henry L-Y Chan; H. Janaka de Silva; Nancy W-Y Leung; Seng-Gee Lim; Geoffrey C. Farrell; the Asia-Pacific Working Party on NAFLD (2007)1

Disclosures

J Gastroenterol Hepatol. 2007;22(6):801-808. 

In This Article

Abstract and Introduction

Evidence-based management guidelines for non-alcoholic fatty liver disease (NAFLD) are lacking in the Asia–Pacific region or elsewhere. This review reports the results of a systematic literature search and expert opinions. The Asia–Pacific Working Party on NAFLD (APWP-NAFLD) has generated practical recommendations on management of NAFLD in this region. NAFLD should be suspected when there are metabolic risk factors and/or characteristic changes on hepatic ultrasonography. Diagnosis by ultrasonography, assessment of liver function and complications, exclusion of other liver diseases and screening for metabolic syndrome comprise initial assessment. Liver biopsy should be considered when there is diagnostic uncertainty, for patients at risk of advanced fibrosis, for those enrolled in clinical trials and at laparoscopy for another purpose. Lifestyle measures such as dietary restrictions and increased physical activity (aerobic exercise) should be encouraged, although the best management strategy to achieve this has yet to be defined. Complications of metabolic syndrome should be screened for regularly. Use of statins to treat hypercholesterolemia is safe and recommended; frequent alanine aminotransferase (ALT) monitoring is not required. Obese patients who do not respond to lifestyle measures should be referred to centers specializing in obesity management; consideration should be given to bariatric surgery or gastric ballooning. The role of pharmacotherapy remains investigational and is not recommended for routine clinical practice. Non-alcoholic fatty liver disease should be recognized as part of the metabolic syndrome and managed in a multidisciplinary approach that addresses liver disease in the context of risk factors for diabetes and premature cardiovascular disease. Lifestyle changes are the first line and mainstay of management.

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in Asia.[1,2] Some patients will develop histologic necroinflammation and fibrosis, that is, non-alcoholic steatohepatitis (NASH), and this may progress to cirrhosis and hepatocellular carcinoma (HCC). The management of NAFLD includes accurate diagnosis of the condition, careful assessment of risk factors associated with advanced liver disease, screening for metabolic syndrome and its complications, lifestyle modification (both physical activity and diet), consideration of obesity management including bariatric surgery, and, presently only in clinical trials, pharmacological treatment.

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