NAFLD: A Practical Approach to Treatment
NAFLD: A Practical Approach to Treatment
Non-alcoholic fatty liver disease (NAFLD) affects up to a third of the population in many developed countries. Between 10% and 30% of patients with NAFLD have non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis. There are metabolic risk factors common to both NAFLD and cardiovascular disease, so patients with NASH have an increased risk of liver-related and cardiovascular death. Management of patients with NAFLD depends largely on the stage of disease, emphasising the importance of careful risk stratification. There are four main areas to focus on when thinking about management strategies in NAFLD: lifestyle modification, targeting the components of the metabolic syndrome, liver-directed pharmacotherapy for high risk patients and managing the complications of cirrhosis.
Non-alcoholic fatty liver disease (NAFLD) is now the commonest cause of chronic liver disease in many developed countries. Up to a third of the population have evidence of steatosis on imaging, with the majority (70%–90%) having simple steatosis. However, 10%–30% of subjects with NAFLD have non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis, which puts patients at risk of liver-related complications. Due to the metabolic risk factors that are common to both NAFLD and cardiovascular disease, patients with NASH have an increased risk of cardiovascular death as well as liver-related mortality. In the first part of this review, we discussed the diagnosis and staging of patients with NAFLD and the importance of risk stratification. Here we will discuss the management of patients with NAFLD.
Abstract and Introduction
Abstract
Non-alcoholic fatty liver disease (NAFLD) affects up to a third of the population in many developed countries. Between 10% and 30% of patients with NAFLD have non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis. There are metabolic risk factors common to both NAFLD and cardiovascular disease, so patients with NASH have an increased risk of liver-related and cardiovascular death. Management of patients with NAFLD depends largely on the stage of disease, emphasising the importance of careful risk stratification. There are four main areas to focus on when thinking about management strategies in NAFLD: lifestyle modification, targeting the components of the metabolic syndrome, liver-directed pharmacotherapy for high risk patients and managing the complications of cirrhosis.
Introduction
Non-alcoholic fatty liver disease (NAFLD) is now the commonest cause of chronic liver disease in many developed countries. Up to a third of the population have evidence of steatosis on imaging, with the majority (70%–90%) having simple steatosis. However, 10%–30% of subjects with NAFLD have non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis, which puts patients at risk of liver-related complications. Due to the metabolic risk factors that are common to both NAFLD and cardiovascular disease, patients with NASH have an increased risk of cardiovascular death as well as liver-related mortality. In the first part of this review, we discussed the diagnosis and staging of patients with NAFLD and the importance of risk stratification. Here we will discuss the management of patients with NAFLD.
