User:Pal Manickam

Non Alcoholic Fatty Liver Disease (NAFLD)

Definition:

A condition where liver is accumulated with fat and usually associated with metabolic conditions. Risk factors for NAFLD included obesity, diabetes and dyslipidemia.

Categories:

NAFLD is sub categorixed into non alcoholic fatty liver (NAFL) and non alcoholic steatohepatosis (NASH). NAFL has just fat accumulation whereas NASH has fat as well as inflammation of the liver tissues.

Prevalence of NAFLD:

Prevalence varies widely and it depends on age, sex and race of the population. Studies show that men are at highest risk for NAFLD, 31% in men Vs 16% in women. Compared to non-Hispanic whites, Hispanics have higher prevalence of NAFLD.

Who are at High Risk: People with the following conditions are at high risk to develop NAFLD,

       Obesity, Type 2 diabetes mellitus, Dyslipidemia, Metabolic syndrome,  Polycystic ovary syndrome, Hypothyroidism, Obstructive Sleep apnea, Hypopituitarism, Hypogonadism, Pancreato-duodenal resection.

When to Obtain a Liver Biopsy in Patients with NAFLD?

Liver biopsy will be needed when the diagnosis of liver disease is uncertain and other causes need to be ruled out.

Is there a screening test?!

Due to the increased morbidity and mortality, a screening test if present will be helpful. But, in most cases liver function will be normal and cannot be a good sensitive test. USG of liver will give more helpful information about the liver but it is expensive making screening test less affordable. SO, high risk patients are offered USG of liver.

                         Management of NAFLD

Initial step - Making the diagnosis:

1. Diagnosis of NAFLD requires that (a) there is hepatic steatosis by imaging or histology, (b) there is no significant alcohol consumption, (c) there are no other causes for hepatic steatosis, and (d) there are no co-existing causes for chronic liver disease.

1. Exclude other causes of hepatic steatosis like significant alcohol consumption, hepatitis C, medications, parenteral nutrition, Wilson’s disease, and severe malnutrition, other chronic liver disease including hemochromatosis, autoimmune liver disease and chronic viral hepatitis.

1. Liver biopsy is the gold standard for characterizing liver histology in patients with NAFLD. Due to procedural risk, cost, it should be performed in those who would benefit the most from diagnostic, therapeutic guidance, and prognostic perspectives.