NAFLD: A Practical Approach to Treatment
NAFLD: A Practical Approach to Treatment
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 (figure 1).
(Enlarge Image)
Figure 1.
Management strategies in non-alcoholic fatty liver disease (NAFLD).
All patients with NAFLD require advice about lifestyle modification aimed at weight loss and increased physical activity, as well as treatment of any associated metabolic risk factors (diabetes, hypertension and dyslipidaemia). For patients with simple steatosis, which carries a relatively benign liver-related prognosis, this can be done in a primary care setting. Patients with steatohepatitis and fibrosis are at highest risk of developing progressive liver disease so require more aggressive lifestyle modification and if this fails can be considered for liver-directed pharmacotherapy with pioglitazone or vitamin E. For patients who have progressed to cirrhosis, surveillance for hepatocellular carcinoma (HCC) is essential and some treatments have been shown to reduce the risk of HCC. Interventions for the treatment of NAFLD are summarised in Table 1.
Principles of Management of NAFLD
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 (figure 1).
(Enlarge Image)
Figure 1.
Management strategies in non-alcoholic fatty liver disease (NAFLD).
All patients with NAFLD require advice about lifestyle modification aimed at weight loss and increased physical activity, as well as treatment of any associated metabolic risk factors (diabetes, hypertension and dyslipidaemia). For patients with simple steatosis, which carries a relatively benign liver-related prognosis, this can be done in a primary care setting. Patients with steatohepatitis and fibrosis are at highest risk of developing progressive liver disease so require more aggressive lifestyle modification and if this fails can be considered for liver-directed pharmacotherapy with pioglitazone or vitamin E. For patients who have progressed to cirrhosis, surveillance for hepatocellular carcinoma (HCC) is essential and some treatments have been shown to reduce the risk of HCC. Interventions for the treatment of NAFLD are summarised in Table 1.