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Diagnosis, treatment of non-alcoholic fatty liver disease (NAFLD)

Pank Jit Sin
17 Apr 2015

Diagnosis and treatment of NAFLD isn’t always precise, but new developments are helping to pave the way for better management of the disease, shares a panel of experts.

Speaking on the options for noninvasive diagnosis of NAFLD, Dr. Yusuf Yilmaz, of the department of gastroenterology, Marmara University, Istanbul, Turkey, said diagnosis of steatosis can be performed using ultrasonography but only for those with more than 30 percent steatosis.  As for the use of biomarkers in the prediction of non-alcoholic steatohepatitis (NASH), Yusuf said the CK18 fragment is still the only biomarker which has been extensively validated. However, he cautioned that the test is far from perfect and yet to make its way into widespread clinical practice.

With regards to fibrosis prediction, the only model adequately validated for clinical use is the NAFLD Fibrosis Score. At the end of the day, Yusuf noted that noninvasive tests are currently insufficient to replace biopsy. However, liver biopsy is avoidable in a large number of cases. Elastography can be used to predict advanced fibrosis and to help in the decision to perform liver biopsy. 

All NAFLD patients to receive lifestyle advice
Weight reduction via lifestyle modification and improvement should be dictated to all patients with NAFLD, said Dr. Elisabetta Bugianesi.

Bugianesi, associate professor of gastroenterology, University of Turin, Italy, said this was because weight reduction through lifestyle modification with diet and exercise leads to improvement of cardiovascular risk profile, improvement of steatosis and probable reduction in inflammation (of the liver). In general, NAFLD patients lack confidence to exercise and have scarce readiness to embrace lifestyle changes. Bugianesi recommended that these patients be afforded behavioural counselling in order to help them overcome their reluctance.

Beyond lifestyle modifications, typical treatments for NAFLD include statins, omega-3 fatty acids, metformin, vitamin E, and various other antidiabetics. Pharmacologic therapy should only be reserved for patients with NASH and even then only for those with advanced fibrosis and at high risk of disease progression. The first-line pharmacotherapy for NASH should be pioglitazone (off-label use outside of type 2 diabetes) or vitamin E or a combination of both.

Bugianesi alluded to pharmacological agents such as ethyl icosapentate, obethicolic acid, simtuzumab, GFT505, liraglutide and losartan, in the pipeline for treatment of fatty liver. However, these compounds still need to undergo placebo-controlled trials before being released to the population.  

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Most Read Articles
Stephen Padilla, 05 Jan 2018
The addition of an antihypertensive drug from a new class to a patient’s regimen results in huge decreases in systolic blood pressure (SBP) and major cardiovascular (CV) events among those at high risk for CV events but without diabetes, suggests a recent study. Its effects on SBP remain large and similar in magnitude across all levels of baseline drug use and all subgroups of patients.
Pearl Toh, 3 days ago
A study finds no evidence that using pharmaceutical aids alone for smoking cessation helps improve the chances of successful quitting despite promising results in previous randomized trials and routine prescription of such drugs to help quit smoking.
04 Jan 2018
Thromboembolism is a major cause of death in patients with cancer, which is why clinicians should check for the symptoms of thromboembolic events right from the initial stages of bevacizumab treatment, suggests a recent study.
04 Jan 2018
Statins appear to reduce the severity of acute pancreatitis (AP), as demonstrated by a decrease in overall incidence of multisystem organ failure (MSOF), according to a study.