Management of NAFLD: a stage-based approach

  title={Management of NAFLD: a stage-based approach},
  author={Mary E. Rinella and Arun J. Sanyal},
  journal={Nature Reviews Gastroenterology and Hepatology},
  • M. RinellaA. Sanyal
  • Published 1 April 2016
  • Medicine, Biology
  • Nature Reviews Gastroenterology and Hepatology
NAFLD is the most prevalent form of liver disease in the USA, affecting an estimated 30% of the population. The condition is associated with increased mortality related to cardiovascular disease, malignancy and liver disease. Identification of patients who might be at increased risk of adverse outcomes is critical as it is not feasible to screen all patients with suspected NAFLD. Patients with NASH, the progressive subtype of NAFLD, should be targeted for treatment, especially if they have… 

Detection of NAFLD/NASH in the General Population and in Primary Care Clinics

With the advent of pharmaceutical treatments for NASH, which are expected in the near future, low cost, readily available prediction models will assist in identifying suitable patients for treatment and the implementation of predictive models for risk stratification may change the landscape of early detection in non-specialist clinical settings.

NASH‐related cirrhosis: An occult liver disease burden

The diagnosis of cirrhosis and advanced fibrosis in the setting of NAFLD is frequently missed by physicians and several simple scores would have helped to provide an earlier diagnosis, showing that an untimely diagnosis may impact a patient’s outcome.

Agents for the treatment of fatty liver disease: focus on essential phospholipids

Essential phospholipids (EPLs) have been safely used for many years as hepatoprotection in patients with liver disease and are recommended as supportive treatment by some NAFLD treatment guidelines.

Managing nonalcoholic fatty liver disease in patients living with HIV

Although additional work is needed to understand the natural history of NAFLD in patients with HIV and identify those at highest risk, novel treatment approaches are now being tested in this population and the authors may soon have effective treatments to combat this epidemic.

Nonalcoholic Fatty Liver Disease Screening in Type 2 Diabetes Mellitus Patients in the Primary Care Setting

A simple noninvasive algorithm can be easily incorporated into the existing workflow in the primary care or diabetology clinic to identify patients at high risk for NASH and advanced fibrosis who should be referred to liver specialists.

Recommendations for Management and Treatment of Nonalcoholic Steatohepatitis

The available evidence is described and consensus guidance is provided on the lifestyle and pharmacologic therapies of NAFLD, and the consensus position on alcohol use in patients withNAFLD is described.

Nonalcoholic fatty liver disease - A multisystem disease?

NAFLD is a direct cause of many chronic diseases associated with MetS, and better detection and treatment of fatty liver disease is therefore urgently needed, as non-invasive screening methods for liver disease become increasingly available.

Insights into the Epidemiology, Pathogenesis, and Therapeutics of Nonalcoholic Fatty Liver Diseases

The current epidemiology, diagnosis, animal models, pathogenesis, and treatment strategies for NAFLD are comprehensively reviewed, emphasizing the outstanding breakthroughs in the above fields and promising medications in and beyond phase II.

Fibrosis Severity as a Determinant of Cause-Specific Mortality in Patients With Advanced Nonalcoholic Fatty Liver Disease: A Multi-National Cohort Study.

Patients with NAFLD cirrhosis have predominantly liver-related events, whereas those with bridging fibrosis have predominantly nonhepatic cancers and vascular events, and moderate alcohol consumption was associated with these outcomes only in patients with Cirrhosis.

Current treatment paradigms and emerging therapies for NAFLD/NASH.

The role of lifestyle intervention, pharmacological agents, surgical approaches, and gut microbiome, with regard to therapy for NASH are discussed, and the role of insulin sensitizers, thyroid hormone mimetics, antioxidants, cholesterol lowering drugs, incretins and cytokines are focused on as therapeutic targets.



Fibrosis stage is the strongest predictor for disease‐specific mortality in NAFLD after up to 33 years of follow‐up

NAFLD patients have increased risk of death, with a high risk ofdeath from cardiovascular disease and liver‐related disease, and the NAS was not able to predict overall mortality, whereas fibrosis stage predicted both overall and disease‐specific mortality.

Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease.

NAFLD fibrosis score appears to be the best indicator of patients at risk, based on HRs, for liver-related complications or death in patients with nonalcoholic fatty liver disease.

Long‐term follow‐up of patients with NAFLD and elevated liver enzymes

It is concluded that nonalcoholic fatty liver disease with elevated liver enzymes is associated with a clinically significant risk of developing end‐stage liver disease and Survival is lower in patients with NASH, and most NAFLD patients will develop diabetes or impaired glucose tolerance in the long term.

The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD

A simple scoring system accurately separates patients with nonalcoholic fatty liver disease with and without advanced fibrosis, rendering liver biopsy for identification ofAdvanced fibrosis unnecessary in a substantial proportion of patients.

Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values

The entire histologic spectrum of NAFLD can be seen in individuals with normal ALT values, and the Histologic spectrum in these individuals is not significantly different from those with elevated ALT levels, which means a lownormal ALT value does not guarantee freedom from underlying steatohepatitis with advanced fibrosis.

Liver fibrosis in overweight patients.

Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States

After a median follow‐up of 14.5 years, NAFLD was not associated with higher mortality, but advanced fibrosis, as determined by noninvasive fibrosis marker panels, is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors.