Nonalcoholic fatty liver disease – NAFLD – is fairly common among our adult patients, and is increasing in prevalence in our pediatric patients as well. You know the scenario. A person’s transaminases are a bit high on routine screening. Ultrasound shows “fatty infiltration.” The patient is not symptomatic as far as liver problems. And the question is, what to do? Biopsy? Medication? Does weight loss help?
Some clarity has recently arrived with the June publication of guidelines for managing NAFLD published by the American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association. You can find the complete guideline at this link: http://onlinelibrary.wiley.com/doi/10.1002/hep.25762/pdf, but just a few of the key take-home points are:
- Routine screening for NAFLD in primary care clinics is not recommended.
- Screening of family members of patients with NAFLD is not recommended.
- When evaluating a patient with possible NAFLD, it is important to look for other possible etiologies of chronic liver disease.
- Weight loss can help reduce steatosis.
- Vitamin E at a dose of 800 IU daily improves liver histology in non-diabetic adults with NAFLD, but be aware that vitamin E supplementation may increase the risk of prostate cancer.
- NAFLD patients should be counseled to avoid heavy alcohol intake.
There are many other helpful tips in the guidelines, which are down-to-earth and easy to peruse. Since the prevalence of NAFLD seems to be increasing as the country’s weight increases, it is a condition we will be seeing more in the years ahead. Having some solid, evidence-based recommendations to follow can provide a firm foundation for how to proceed.
Richard Fleming, MD