Nonalcoholic Fatty Liver Disease

Implications for Clinical Practice and Health Promotion

Bethany Croke, FNP-BC; Deborah Sampson, FNP-BC

Journal for Nurse Practitioners. 2012;8(1):45-50.

Epidemiology

An estimated 20% to 30% of the American adult population has some form of NAFLD.^[1] Furthermore, approximations state that up to 80% of obese people have the disease.^[5] Fatty liver and NASH occur in both pediatric and adult patients, with the highest prevalence in the 40- to 49-year-old age group. It is the most common liver abnormality in children ages 2 to 19.^[9] The disease appears equally in men and women and across all ethnicities. In the United States the prevalence is higher in the Hispanic population compared to Caucasian and African American populations.

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Table 1. Nonalcoholic Fatty Liver Disease Presentation
Early Adult Symptoms Asymptomatic Fatigue Right upper quadrant pain Late Adult Symptoms Anorexia Ascites Jaundice Pruritis Common Adult and Pediatric Symptoms Hepatomegaly Obesity Rare Adult Symptoms Palmar erythema Spider nevi Specific Pediatric Symptoms Fatigue Hepatomegaly Increased waist circumference Malaise Obesity with central adiposity Right-upper quadrant or epigastric pain

Table 2. Patient Assessment of Nonalcoholic Fatty Liver Disease
Subjective Personal and family history of non-alcoholic fatty liver disease, type 2 diabetes, metabolic syndrome, hypertriglyceridemia, biliary tract disease Alcohol intake Risk factors for viral hepatitis: injection drug use, high-risk sexual behavior, blood transfusions Toxin exposure (eg, acetaminophen, alcohol) Medications: amiodarone, diltiazem, tamoxifen, tetracycline, valproate, methotrexate, steroids, highly-active antiretrovirals Rapid weight loss Diet and exercise habits Objective Body mass index Obesity Hepatomegaly Liver function tests Fasting lipid panel Glucose

Table 3. Treatment and Management of Nonalcoholic Fatty Liver Disease
Nonpharmacological Slow, 10% reduction of body weight Healthy diet: low saturated fat, high fiber Exercise Avoidance of common hepatotoxins: alcohol, acetaminophen Patient education of condition Pharmacological Targeting dyslipidemia Fibrates Statins Targeting insulin resistance Biguanides Thiazolidinediones Other (strong effectiveness not yet proven) Betaine Ursodeoxycholic acid Vitamin E Rarer Methods (after other methods fail) Gastric bypass Liver transplant

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