Materiały źródłowe

• #1 Nonalcoholic fatty liver disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567

  Nonalcoholic fatty liver disease, often called NAFLD, is a liver problem that affects people who drink little to no alcohol. In NAFLD, too much fat builds up in the liver. It is seen most often in people who are overweight or obese. […] NAFLD is becoming more common, especially in Middle Eastern and Western nations as the number of people with obesity rises. It is the most common form of liver disease in the world. NAFLD ranges in severity from hepatic steatosis, called fatty liver, to a more severe form of disease called nonalcoholic steatohepatitis (NASH). […] NASH causes the liver to swell and become damaged due to the fat deposits in the liver. NASH may get worse and may lead to serious liver scarring, called cirrhosis, and even liver cancer. This damage is like the damage caused by heavy alcohol use.

• #1 Nonalcoholic Fatty Liver Disease (NAFLD)

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/

  Nonalcoholic fatty liver disease (NAFLD), now called metabolic dysfunction-associated steatotic liver disease (MASLD), is the buildup of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% 10% percent of the livers weight is fat, then it is called a fatty liver (steatosis). The more advanced form of NAFLD is nonalcoholic steatohepatitis (NASH), now called metabolic dysfunction-associated steatohepatitis (MASH). NASH causes the liver to swell and become damaged. […] We encourage adults living with MASH/NASH to visit our MASH Featured Clinical Trial page to learn more about potential opportunities in their area. Visit the page today. […] Nonalcoholic fatty liver disease (now known as MASLD) tends to develop in people who are overweight or obese or have diabetes, high cholesterol, or high triglycerides. These conditions combined are known as metabolic syndrome. Rapid weight loss and poor eating habits also may lead to NAFLD. Certain medications may increase ones chances of developing NAFLD. It is important to note, however, that some people develop fatty liver even if they do not have the most common risk.

• #2 Nonalcoholic Fatty Liver Disease (NAFLD)

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/

  Nonalcoholic fatty liver disease (NAFLD), now called metabolic dysfunction-associated steatotic liver disease (MASLD), is the buildup of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% 10% percent of the livers weight is fat, then it is called a fatty liver (steatosis). The more advanced form of NAFLD is nonalcoholic steatohepatitis (NASH), now called metabolic dysfunction-associated steatohepatitis (MASH). NASH causes the liver to swell and become damaged. […] We encourage adults living with MASH/NASH to visit our MASH Featured Clinical Trial page to learn more about potential opportunities in their area. Visit the page today. […] Nonalcoholic fatty liver disease (now known as MASLD) tends to develop in people who are overweight or obese or have diabetes, high cholesterol, or high triglycerides. These conditions combined are known as metabolic syndrome. Rapid weight loss and poor eating habits also may lead to NAFLD. Certain medications may increase ones chances of developing NAFLD. It is important to note, however, that some people develop fatty liver even if they do not have the most common risk.

• #3 NASH Definition & Progression

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-definition-prevalence/

  Fatty liver disease is a condition in which excess fat is stored inside liver cells, making it harder for the liver to function. One cause of fat buildup in the liver is heavy alcohol use, referred to as alcoholic fatty liver disease. This is a common, but preventable disease and is the earliest stage of alcohol-related liver disease. When the buildup of fat in the liver is not related to significant alcohol consumption, the condition is called nonalcoholic fatty liver disease (NAFLD). […] NAFLD is a general term for a range of conditions characterized by extra fat in liver cells that is not caused by alcohol. Its normal for the liver to contain some fat. However, if more than 5 percent of the livers weight is fat, its considered a fatty liver (steatosis). There are two different types of nonalcoholic fatty liver disease: Simple fatty liver and Nonalcoholic steatohepatitis (NASH). In this form of NAFLD you have fat in your liver, but little or no inflammation of the liver or damage to liver cells. Your healthcare provider may refer to this as nonalcoholic fatty liver (NAFL). Typically, this form does not progress to cause liver damage. This is the more severe form of NAFLD in which you have hepatitis meaning swelling or inflammation of the liver and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. Fibrosis can progress to cirrhosis, where hard scar tissue replaces an increasingly larger amount of soft healthy liver tissue. Cirrhosis from NASH typically takes years of damage to develop.

• #4 NASH Definition & Progression

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-definition-prevalence/

  NAFLD is the most common chronic liver condition in the United States. Its estimated that about 25 percent of adults in the U.S. have NAFLD. Of those with NAFLD, about 20 percent have NASH (5% of adults in the U.S.). Most people with NAFLD have simply fatty liver. The reason some people with NAFLD have simple fatty liver and others get NASH isnt known, although research suggests that certain genes may play a role. NAFLD is newly renamed metabolic dysfunction-associated steatotic liver disease or MASLD. NASH has been newly renamed metabolic dysfunction associated steatohepatitis or MASH. Fatty liver disease is newly renamed steatotic liver disease.

• #5 Nonalcoholic Fatty Liver Disease | UI Health

  https://hospital.uillinois.edu/primary-and-specialty-care/hepatology-liver-disease/areas-of-expertise/nonalcoholic-fatty-liver-disease

  Non-alcoholic fatty liver disease (NAFLD) is the accumulation of excess fat in the liver of people who drink little or no alcohol. Obesity is the most common cause of the disease. Risk factors include having high blood-fat levels, either triglycerides or LDL („bad”) cholesterol, diabetes, or high blood pressure. This disease is common, and symptoms such as fatigue, upper-right abdominal pain, and weight loss may arise sometimes due to NAFLD. […] Losing weight, lowering bad cholesterol, reducing blood pressure, controlling diabetes, avoiding alcohol use, and limiting over-the-counter drugs through lifestyle changes or medications are recommended as a treatment for NAFLD.

• #6 Nonalcoholic Fatty Liver Disease: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0701/p35.html

  Nonalcoholic fatty liver disease is characterized by excessive fat accumulation in the liver (hepatic steatosis). Nonalcoholic steatohepatitis is characterized by steatosis, liver cell injury, and inflammation. The mechanism of nonalcoholic fatty liver disease is unknown but involves the development of insulin resistance, steatosis, inflammatory cytokines, and oxidative stress. Nonalcoholic fatty liver disease is associated with physical inactivity, obesity, and metabolic syndrome. Screening is not recommended in the general population. The diagnosis is usually made after an incidental discovery of unexplained elevation of liver enzyme levels or when steatosis is noted on imaging (e.g., ultrasonography). Patients are often asymptomatic and the physical examination is often unremarkable. No single laboratory test is diagnostic, but tests of liver function, tests for metabolic syndrome, and tests to exclude other causes of abnormal liver enzyme levels are routinely performed. Imaging studies, such as ultrasonography, computed tomography, and magnetic resonance imaging, can assess hepatic fat, measure liver and spleen size, and exclude other diseases. Liver biopsy remains the criterion standard for the diagnosis of nonalcoholic steatohepatitis. Noninvasive tests are available and may reduce the need for liver biopsy. A healthy diet, weight loss, and exercise are first-line therapeutic measures to reduce insulin resistance. There is insufficient evidence to support bariatric surgery, metformin, thiazolidinediones, bile acids, or antioxidant supplements for the treatment of nonalcoholic fatty liver disease. The long-term prognosis is not associated with an increased risk of all-cause mortality, cardiovascular disease, cancer, or liver disease.

• #7 Nonalcoholic fatty liver disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/diagnosis-treatment/drc-20354573

  Because NAFLD typically causes no symptoms, it is often found when tests done for other reasons point to a liver problem. […] Our caring team of Mayo Clinic experts can help you with your nonalcoholic fatty liver disease-related health concerns. […] Treatment for NAFLD usually starts with weight loss. This can be done by eating a healthy diet, limiting portion sizes and exercise. Losing weight may improve other health problems that lead to NAFLD. […] With help from your health care team, you can take steps to manage nonalcoholic fatty liver disease. You can: […] If you find out you have nonalcoholic fatty liver disease, some basic questions to ask include: […] If your doctor suspects a liver problem, such as nonalcoholic fatty liver disease, you may be referred to a doctor who specializes in the liver, called a hepatologist.

• #8 Nonalcoholic Fatty Liver Disease (NAFLD)

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/

  Nonalcoholic Fatty Liver Disease, or NAFLD (now known as MASLD, or Metabolic Associated Steatotic Liver Disease) and cardiac (heart) disease have similar causes, including metabolic syndrome. […] Current medical recommendations suggest the importance of discussing the NAFLD/heart disease connection with a health care provider if you have NAFLD. […] Nonalcoholic fatty liver disease (now called MASLD) can get worse and cause liver inflammation (enlargement or swelling) and damage called nonalcoholic steatohepatitis (NASH, which has been renamed MASH). Cirrhosis (scar buildup) can develop if NASH advances. Early diagnosis of NAFLD, along with following medical advice, can reduce a persons chance NAFLD progressing to NASH and cirrhosis. […] Nonalcoholic fatty liver disease (now called MASLD) often has no symptoms, but if they occur, If symptoms begin, they usually include fatigue (extreme tiredness), weakness, discomfort or pain in the abdomen.

• #9 Nonalcoholic fatty liver disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567

  NAFLD often has no symptoms. When it does, they may include fatigue, not feeling well, or malaise, and pain or discomfort in the upper right belly area. […] Possible symptoms of NASH and cirrhosis, or severe scarring, include itchy skin, abdominal swelling, shortness of breath, swelling of the legs, spider-like blood vessels just beneath the skin’s surface, enlarged spleen, red palms, and yellowing of the skin and eyes, or jaundice. […] Make an appointment with a member of your health care team if you have lasting symptoms that worry you. […] To reduce your risk of NAFLD: Eat a healthy diet that’s rich in fruits, vegetables, whole grains and healthy fats; limit alcohol, simple sugars and portion sizes; keep a healthy weight; and exercise. […] Severe liver scarring, or cirrhosis, is the main complication of NAFLD and NASH. Cirrhosis happens because of liver injury, such as the damage caused by inflammation in NASH.

• #10 Nonalcoholic Fatty Liver Disease (NAFLD)

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/

  If NALFD begins to advance to NASH (now known as MASH), other symptoms may begin. These can include jaundice (yellowing of the eyes and skin), severe itching, fluid buildup in the belly (ascites) and fluid buildup in the ankles (edema). Sometimes mental confusion can occur. […] Nonalcoholic fatty liver disease (now called MASLD) may be suspected if blood tests show higher than normal levels of liver enzymes. […] There are no medications approved yet for nonalcoholic fatty liver disease (now called MASLD). Eating a healthy diet and adding physical movement to your day may help prevent liver damage from starting or reverse it in the initial stages. […] There are things people can do to lower their chances of developing NAFLD (now called MASLD). They include: Maintain a healthy weight. […] While NAFLD (now called MASLD) can affect people of all ages, sexes, and ethnicities, it is important to consider its specific implications during pregnancy and in those intending to become pregnant.

• #11 Non-alcoholic fatty liver disease: leading the fight in primary care | British Journal of General Practice

  https://bjgp.org/content/72/723/499

  GPs are no strangers to non-alcoholic fatty liver disease (NAFLD) and are commonly faced with non-specific liver function tests (LFTs) or an incidental finding of steatosis on ultrasound scan (USS). […] NAFLD is a spectrum of liver abnormalities from simple fat deposition (steatosis) to inflammation (non-alcoholic steatohepatitis, NASH). […] The majority of diagnoses occur in primary care, where clinicians can identify those at risk, initiate investigations, and advise regarding modifiable lifestyle factors. […] NAFLD usually presents with either deranged LFTs or an incidental finding on an USS; however, the majority of patients with NAFLD have normal LFTs. […] Current recommendations are for patients with deranged LFTs, regardless of metabolic risk factors, to have a full non-invasive liver screen.

• #12 Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/clinical-care-pathway-for-the-risk-stratification-and-management-of-patients-with-nonalcoholic-fatty-liver-disease-nafld/

  AGA convened international experts in nonalcoholic fatty liver disease (NAFLD) to outline the spectrum of care from screening and diagnosis to patient care management. […] Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease (NAFLD) […] NAFLD/NASH screening steps […] Step 1: Identifying patients with clinically significant hepatic fibrosis (fibrosis stage 2 or higher) is important for targeted efforts at preventing disease progression. These groups include patients with type 2 diabetes, patients with two or more metabolic risk factors, and those with incidental findings of hepatic steatosis or elevated amino transferases. […] Step 2: All at-risk patients identified in Step 1 should be screened for alcohol use and undergo liver function tests (or comprehensive metabolic panel, if done as part of routine care) and a complete blood count as part of the initial screening process.

• #13 Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/clinical-care-pathway-for-the-risk-stratification-and-management-of-patients-with-nonalcoholic-fatty-liver-disease-nafld/

  Step 3: All individuals in the target risk groups should undergo non-invasive testing for clinically significant liver fibrosis using simple, non-proprietary fibrosis scores. […] Step 4: Patients with discordant or indeterminate liver stiffness measurement (LSM) results (8.0 to 12.0 kPa) in primary care and endocrine clinics should be referred to hepatology where they may need to undergo either a liver biopsy or magnetic resonance elastography (MRE) for further diagnostic evaluation. […] Management of NAFLD/NASH […] A multidisciplinary team, including a primary care provider, an endocrinologist for patients with diabetes, and a gastroenterologist/hepatologist, is needed to successfully manage the complexity of care posed by high-risk patients due to obesity, diabetes, CVD and NALFD with fibrosis. The primary goal of screening these patients is to implement early interventions to prevent the development of cirrhosis and liver-related and all-cause mortality.

• #14 Nonalcoholic Fatty Liver Disease: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0701/p35.html

  Patients with nonalcoholic fatty liver disease should be evaluated for metabolic syndrome and insulin resistance. […] In patients with nonalcoholic fatty liver disease, a healthy diet, weight loss, and exercise should be recommended as first-line therapeutic measures to reduce insulin resistance. […] A healthy diet, weight loss, and exercise are first-line therapeutic measures to reduce insulin resistance in patients with nonalcoholic fatty liver disease. […] Although there is no established treatment, a healthy low-fat diet may have benefits independent of weight loss. A modest weight loss of 5% to 10% can result in normalization of AST levels. […] Patients should be encouraged to increase physical activity and exercise, because these have been shown to reduce steatosis and improve liver enzyme levels independent of weight loss. […] A systematic review of two randomized trials and four prospective cohort studies found that pentoxifylline reduced AST and ALT levels, although the study did not examine improvements in patient morbidity or mortality.

• #15

  https://www.nursingcenter.com/journalarticle?Article_ID=5473730&Journal_ID=54016&Issue_ID=5473671

  Nonalcoholic fatty liver disease (NAFLD) is defined as storage of excess fat in the liver not caused by heavy alcohol consumption. Nonalcoholic steatohepatitis is the severe form of NAFLD. This article discusses causes, diagnosis, and nursing interventions for patients with either disorder. […] This article discusses causes, diagnosis, and nursing interventions for patients with NAFLD and NASH. […] A fundamental component of NAFLD and NASH management is lifestyle modification. Importantly, this includes avoiding alcohol, a known hepatotoxin, to prevent further liver damage. […] Dietary and calorie restriction are key interventions in preventing and managing NAFLD. […] To promote weight loss, if indicated, and encourage lifestyle and dietary modifications, nurses should explain the implications of metabolic syndrome to their patients.

• #16

  https://www.nursingcenter.com/journalarticle?Article_ID=5473730&Journal_ID=54016&Issue_ID=5473671

  Nurses are in a strategic position to educate patients, caregivers, and families about NAFLD and NASH. Collaborating with healthcare team members in other disciplines, nurses can work with patients and families to develop a practical plan of care that will help patients lose and maintain weight, make informed dietary choices, and manage comorbidities such as diabetes.

• #17 Practice Nursing – Non-alcoholic fatty liver disease: a global concern

  https://www.practicenursing.com/content/clinical-focus/non-alcoholic-fatty-liver-disease-a-global-concern/

  Non-alcoholic fatty liver disease is an umbrella term used to describe a build-up of fat in the liver. […] In the early stages of non-alcoholic fatty liver disease (NAFLD), the condition does not cause damage and is reversible. […] Nurses are often in the best position to prompt early investigation. Health promotion in the form of lifestyle advice is the mainstay of treatment, with an emphasis on weight reduction and healthy diet.

• #18 Non-alcoholic fatty liver disease (NAFLD) and the cardiovascular disease (CVD) risk categories in primary care: is there an association? | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-020-01306-7

  Non-alcoholic fatty liver disease (NAFLD) is an emerging novel cardiovascular disease (CVD) risk factor. Its prevalence is increasing globally. However, there is paucity in the evidence showing the association between NAFLD and CVD risk in primary care setting. Therefore, the objectives of this study were to determine the prevalence and factors associated with NAFLD among patients with 1 risk factor for NAFLD or CVD attending primary care clinics. […] NAFLD is highly prevalent among patients with 1 risk factor for NAFLD or CVD in these primary care clinics. Patients who were obese, have elevated fasting glucose, elevated ALT and in the high FRS category were more likely to have NAFLD. This study underscores the importance of targeted screening for NAFLD in those with risk factors in primary care. Aggressive intervention must be executed in those with NAFLD in order to reduce CVD complications and risk of progression.

• #19 Challenges in the Management of Non-Alcoholic Fatty Liver Disease (NAFLD): Towards a Compassionate Approach

  https://www.mdpi.com/2673-4389/3/3/31

  Primary care settings play a pivotal role in the care of individuals with NAFLD, including prevention and early diagnosis. However, primary care practitioners (PCPs) may face various challenges in order to adequately assist patients with NAFLD. Indeed, in a study aimed at investigating the needs of primary care providers in terms of the diagnosis and management of NAFLD, Islam et al. identified that although PCPs are on the front line in terms of such issues, many of them lacked confidence when diagnosing the condition and were inconsistent in their approaches to its management. […] Moreover, it is reported that there is a lack of information in relation to the attitudes of PCPs regarding NAFLD. In a survey involving 250 PCPs, Said et al. reported that although 83% of PCPs viewed NAFLD as an important health problem, 85% underestimated the prevalence of NAFLD, and only 46% offered NAFLD screening to patients with obesity and diabetes. In addition, just 27% of PCPs referred patients with NAFLD to a hepatologist. Interestingly, 58% of PCPs reported that the main barrier to NAFLD management was related to a lack of confidence in their understanding of the condition.

• #20 Nonalcoholic Fatty Liver – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541033/

  Patients with NASH are to be followed by hepatologists or gastroenterologists. NASH with cirrhosis requires hepatocellular carcinoma surveillance with an ultrasound every six months. Several clinical trials are being conducted using anti-fibrotic, anti-apoptotic, and immune therapies for the treatment of NAFLD. […] The management of NAFLD will require an interprofessional team that consists of a primary care provider, nurse practitioner, hepatologist or gastroenterologist, nutritionist, endocrinologist, and bariatrician. Primary prevention with adequate management of metabolic derangement is essential to prevent the rising incidence of NAFLD and its associated complications. To lower the risk of heart disease, patients should be urged to reduce body weight, discontinue smoking, eat a healthy diet, and participate in regular exercise. […] Management of NAFLD is optimal with an interprofessional healthcare team that includes providers, specialists, specialty-trained nurses, and, where appropriate, pharmacists. These different disciplines need to engage in open communication with the patient to ensure the best possible outcomes.

• #21 Advancing the global public health agenda for NAFLD: a consensus statement | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-021-00523-4

  As a multisystem, comorbid disease, people living with NAFLD will often benefit from multidisciplinary care, especially those with advanced fibrosis. […] Establishment of multidisciplinary teams (MDTs) can be an effective way to manage the diverse clinical needs of people living with NAFLD. […] The treatment and care of patients with NAFLD are highly dependent on their disease stage. […] Interventions aimed at modifying lifestyle risk factors namely weight, diet and physical activity and at the management of comorbidities should be the cornerstone of treatment for all patients. […] Making effective structured lifestyle treatment programmes available to people with NAFLD, especially those who are at high risk of advanced fibrosis and/or rapid fibrosis progression, such as people living with NAFLD, obesity and T2DM, should be a priority of the liver health community.

• #22 Clinical Care Guidelines & Guidances in NAFLD/NASH – Global Liver Institute

  https://globalliver.org/clinical-care-guidelines-and-guidances-in-nafld-nash/

  Those with NAFLD should be recommended to an individualized exercise regiment that promotes physical activity and sustainable weight loss. […] All guidelines/guidances emphasize management of concurring diseases and conditions ie. obesity, type 2 diabetes, hypertension, metabolic syndrome, etc. […] Lifestyle modifications are necessary. A combination of proper nutrition and increased physical activity are shown to have positive results on NAFLD/NASH regression.

• #23 Non-alcoholic fatty liver disease: A patient guideline

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8514420/

  NAFLD with only fat accumulation in the liver cells and no or only minimal signs of liver cell damage or inflammation, called simple or isolated fatty liver or NAFL, does not usually cause any harm, but if it is not managed, can progress to NASH, which is a more serious condition. […] NASH is more serious than isolated fatty liver because there is inflammation in the liver, and it starts to become damaged. This inflammation can lead to fibrosis, which means scar tissue is forming inside the liver. […] If you are diagnosed with NAFLD, your doctor will talk to you about making healthy diet and lifestyle choices. This is the cornerstone of NAFLD treatment and should always be the first treatment option. There are currently no medicines to specifically treat NAFLD, although research is underway to develop them. Without specific drugs for treatment, weight loss is key, and this can be achieved through a combination of dietary changes and increasing physical activity/exercise levels. These changes can help to reduce the amount of fat and inflammation in your liver.

• #24 Five Things You Should Know About Nonalcoholic Fatty Liver Disease | NYU Langone News

  https://nyulangone.org/news/five-things-you-should-know-about-nonalcoholic-fatty-liver-disease

  For patients who are overweight or obese, weight loss is central to managing the disease. Trimming body weight by as little as 3 percent can decrease the degree of fat deposition in the liver, a 5 percent to 7 percent loss can reduce inflammation, and a 10 percent drop can actually start to reverse scarring, he explains. […] Developing a singularly effective medication for NAFLD has been challenging because the disease is rooted in multiple underlying mechanisms, both genetic and environmental. Still, researchers could be on the verge of a breakthrough. […] Combination therapies that target several disease pathways at once will be a major step forward, explains Dr. Jacobson.

• #25 Non-alcoholic fatty liver disease | Carr Lab | Perelman School of Medicine at the University of Pennsylvania

  https://www.med.upenn.edu/carr-lab/liver-disease.html

  A condition called non-alcoholic fatty liver disease (NAFLD) usually refers to fatty liver that develops as a result of too much fat circulating in the bloodstream. Many of these patients are overweight or obese; have a family or personal history of diabetes, high cholesterol, or high blood pressure (metabolic syndrome); and have a reduced response to an important hormone called insulin. NAFLD affects approximately 30% of the US population. […] To treat non-alcoholic fatty liver disease: Currently, lifestyle changes may ameliorate steatosis. Several research trials showed that weight loss is the most effective way to reduce liver fat; losing at least 3 to 5 percent of the body weight can reduce fat in the liver and there is evidence that 10% weight loss could be associated with a reduction of liver fibrosis.

• #26 Clinical Care Guidelines & Guidances in NAFLD/NASH – Global Liver Institute

  https://globalliver.org/clinical-care-guidelines-and-guidances-in-nafld-nash/

  This guideline was developed by the AACE and co-sponsored by the AASLD to provide evidence-based recommendations regarding the diagnosis and management of NAFLD and NASH to endocrinologists, primary care clinicians, health care professionals, and other stakeholders. […] This practice guidance was developed by the AASLD and provides actionable statements to support providers with the information and pathway for serving liver patients with NAFLD/NASH. […] Management of NAFLD or NASH should be done with multidisciplinary healthcare teams that include a primary care physician, hepatologist, gastroenterologist, and endocrinologist, as needed. […] Lifestyle modification is the preferred way to manage NAFLD/NASH long-term. […] People with NAFLD should be recommended a diet that leads to a calorie deficit, limiting carbohydrates and saturated fats and encouraging high fiber and unsaturated fats.

• #27 Non-alcoholic fatty liver disease | Carr Lab | Perelman School of Medicine at the University of Pennsylvania

  https://www.med.upenn.edu/carr-lab/liver-disease.html

  The Mediterranean diet is another option for the treatment of NAFLD. Mediterranean diet is rich in vegetables, fruits, whole grains, seeds, nuts, legumes, and fish. This diet is rich in monounsaturated fatty acids and polyunsaturated fatty acids as well as fibres and antioxidants and has been shown to reduce hepatic fat and improve hepatic insulin sensitivity even without weight loss. […] Therefore, the combination of calories restriction as well as dietary pattern associated with physical activity needs to be considered in the treatment of NAFLD.

• #28 Non-alcoholic fatty liver disease: a practical approach to treatment | Frontline Gastroenterology

  https://fg.bmj.com/content/5/4/277

  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. […] Lifestyle modification aimed at weight loss and increased physical activity is vital in managing all patients with NAFLD irrespective of their underlying liver histology. […] Patients should be encouraged to avoid a sedentary lifestyle by increasing daily activities, undertaking regular exercise and eating healthily. […] Intensive 12-month dietician-led lifestyle interventions are more effective than standard care for patients with NAFLD in terms of weight loss and achieving remission of NAFLD.

• #29 Non-Alcoholic Fatty Liver Disease | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/fatty-liver-disease-non-alcoholic

  Moderate or heavy alcohol use can cause additional damage and fat accumulation in the liver in people with NAFLD. Therefore, patients with NAFLD should avoid alcohol entirely if possible. If you do not think you can completely stop drinking alcohol, it is important to minimize alcohol intake (less than 2 drinks per day for men and 1 drink per day for women). […] At the University of Michigan Fatty Liver Disease Clinic, we provide the latest diagnostic and treatment options to patients with NAFLD/NASH, as well as access to cutting edge research trials that include new therapies under study.

• #30 Frontiers | Non-alcoholic Fatty Liver Disease and Alcohol-Related Liver Disease: Two Intertwined Entities

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00448/full

  Patients with NAFLD, particularly those with NASH, have an increased mortality due to liver disease, and it is likely that cardiovascular mortality could also be increased. […] The relationship between NAFLD and ALD is complex due to overlapping clinical features and lack of positive criteria for NAFLD. […] Although initially some studies suggested protective effects in moderate doses, current evidence shows that there is no safe threshold for alcohol consumption in the setting of NAFLD. […] The presence of MetS and obesity increases the progression of ALD as well the incidence of HCC and mortality. […] Considering the high prevalence of obesity and MetS and the changing patterns of alcohol consumption worldwide, which may impact the incidence of advanced liver disease, it is necessary to better define both diseases, acknowledge the presence of a dual etiology of liver disease in a group of patients, and develop a multidisciplinary approach focused on preventive measures.

• #31 Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/clinical-care-pathway-for-the-risk-stratification-and-management-of-patients-with-nonalcoholic-fatty-liver-disease-nafld/

  In all risk groups, appropriate physician-patient communication should guide shared decision-making. […] Patients at low-risk of advanced fibrosis should be managed using therapeutic lifestyle interventions, such as weight loss, as appropriate, nutritional strategies, stress management, regular physical exercise and avoiding excess alcohol intake. […] Patients at high-risk advanced fibrosis should be managed by a multidisciplinary team closely coordinated by a hepatologist who can monitor for cirrhosis, hepatocellular carcinoma and other cirrhosis-related complications. […] Patients at indeterminate-risk of advanced fibrosis should be managed using a similar approach to high-risk patients, along with further work-up and efforts to confirm the stage of hepatic fibrosis.

• #32 Non-Alcoholic Fatty Liver Disease | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/fatty-liver-disease-non-alcoholic

  Diagnosis is not always simple because patients usually have no symptoms and liver tests can be completely normal. Diagnosis is typically made if testing for other causes of liver disease is negative and there are findings of fat deposition on imaging tests (like ultrasound, CAT scan or MRI). […] Active research is ongoing, but for now there are no FDA approved medications specifically for the treatment of NAFLD/NASH. However, studies have shown that both fat, inflammation and scar tissue can leave your liver. This means that NAFLD and NASH can be reversible. […] Improving liver fat and inflammation is possible when people lose weight and/or modify their lifestyle. This is the first line treatment for NAFLD/NASH. […] Patients with NASH diagnosed with a liver biopsy and who do not have diabetes, significant heart disease or cirrhosis will sometimes be asked to start Vitamin E as this is thought to help reduce liver inflammation.

• #33 Non-alcoholic fatty liver disease: a practical approach to treatment | Frontline Gastroenterology

  https://fg.bmj.com/content/5/4/277

  Bariatric surgery has an increasing role in the management of patients with obesity and the metabolic syndrome. […] For patients with biopsy-proven NASH, where lifestyle intervention has failed, liver-directed pharmacotherapy with pioglitazone or vitamin E can be considered. […] Vitamin E is an antioxidant that has recently been shown to have beneficial effects on histology in non-diabetic patients with NASH. […] Approximately 40%50% of patients with NAFLD attending secondary care clinics have T2DM and the majority have evidence of insulin resistance. […] It is therefore essential that all patients with NAFLD are regularly screened for diabetes. […] Treatment of diabetes should be escalated if the glycosylated haemoglobin (HbA1c) rises to 7.5%. […] Patients with NASH cirrhosis are at risk of the same complications of cirrhosis as with any other aetiology of liver disease.

• #34 Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

  https://my.clevelandclinic.org/health/diseases/22437-non-alcoholic-fatty-liver-disease

  Your provider may discuss bariatric surgery with you. Bariatric surgery to support weight loss may reverse MASLD that’s diagnosed before you develop cirrhosis. […] Yes, but that depends on your situation. In general, treatment can reverse MASLD unless you have MASH-related cirrhosis. […] If you have obesity or Type 2 diabetes, your healthcare provider may recommend blood and imaging tests to screen for signs of this condition. […] Lifestyle changes like losing weight and being more active can help keep MASLD from getting worse. […] That said, people with MASLD who drink beverages that contain alcohol are likely to develop cirrhosis much faster than usual.

• #35 Nonalcoholic Fatty Liver Disease: Common Questions and Answers on Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1115/p603.html

  Although there is no consensus on monitoring, it is reasonable for primary care clinicians to initiate intensive lifestyle changes and repeat liver enzyme measurements and ultrasonography in six to 12 months. If abnormalities persist and the patient is at low risk of fibrosis, the patient should be monitored every 12 to 24 months with a complete blood count; measurement of liver enzyme, lipid, and fasting glucose or A1C levels; and calculation of fibrosis risk scores (NAFLD Fibrosis Score or Fibrosis-4 Score). High-risk patients should be referred to a specialist. […] Most patients with NAFL will have a benign, nonprogressive disease course. Only 20% develop NASH, and 20% of those with NASH develop cirrhosis. Patients with a higher degree of fibrosis have a higher risk of death, mainly from cardiovascular disease, cancer, and end-stage liver disease.

• #36 An algorithm for the management of non-alcoholic fatty liver disease in primary care – MedCrave online

  https://medcraveonline.com/GHOA/an-algorithm-for-the-management-of-non-alcoholic-fatty-liver-disease-in-primary-care.html

  All patients identified with NAFLD should work with their PCP to manage medical comorbidities. Treat components of metabolic syndrome with medication as indicated. […] Patients with evidence of significant fibrosis (FIB-4 1.3) should be comanaged by their PCP and referred to a hepatologist. […] Lifestyle interventions are key in the clinical management of all spectrums of NAFLD. Weight loss is considered the cornerstone of treatment and shown to improve steatosis, liver injury, and fibrosis. […] All patients with NAFLD need longitudinal follow up. Those identified with minimal fibrosis (FIB-4 1.3, F0-1) can be followed by PCPs to manage metabolic comorbidities, and bi-annual blood work including blood count, liver enzymes, HbA1c, and lipids to monitor and detect metabolic diseases.

• #37 Non-alcoholic fatty liver disease: A patient guideline

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8514420/

  It is important to check your weight, blood glucose, blood pressure and blood lipids (cholesterol, triglycerides) on a regular basis and manage these appropriately to reduce your risk of CVD and T2D. […] The family doctor/GP should be included in the multidisciplinary team. They are important from the outset, identifying the different problems, and helping to monitor disease progression. The family doctor/GP performs a pivotal role as the navigator throughout your NAFLD/NASH treatment. […] When you have NAFLD, the goal is to manage your symptoms, and to prevent your health from getting worse. Although NAFLD progresses very slowly, it is important to eat healthily and increase your physical activity/exercise levels. This will help to improve the health of your liver and lower your risk of worsening health.

• #38 Non-Alcoholic Fatty Liver Disease (NAFLD) Competencies – Canadian Association for Hepatology Nurses

  https://cahn.ca/non-alcoholic-fatty-liver-disease-nafld-competencies/

  The Canadian Association of Hepatology Nurses NAFLD Competencies document provides a mechanism for nurses to examine their practice, determine their learning needs and ultimately improve their knowledge, skill and judgment related to NAFLD care. […] Nurses play a vital role in the education and management of NAFLD in collaboration with other health professionals. […] The CAHN NAFLD Competencies document describes a full range of NAFLD nursing competencies without identifying educational preparation or specific experience needed for any of the competencies. […] These competencies are meant to assist nurses with identification of learning needs appropriate for their particular practice context. […] The nursing assessment sections are framed within the twelve determinants of health. […] The role of income as it relates to food security

• #39 Non-Alcoholic Fatty Liver Disease (NAFLD) Competencies – Canadian Association for Hepatology Nurses

  https://cahn.ca/non-alcoholic-fatty-liver-disease-nafld-competencies/

  Strategies that clients can use to access services such as weight management programs, diabetes management programs, access to recreational facilities, and nutrition counselling (e.g. free dietitian reviews at grocery stores) […] Nurses role in collaborative client care […] Role of specialty nurses educating primary care physicians on NAFLD care pathways […] Awareness of NAFLD education and learning opportunities […] Nurses role in advocating for improvement and access to care and treatment.

• #40 Challenges in the Management of Non-Alcoholic Fatty Liver Disease (NAFLD): Towards a Compassionate Approach

  https://www.mdpi.com/2673-4389/3/3/31

  To date, despite a wealth of literature on NAFLD, management of the condition remains challenging and not straightforward, with most cases in primary care being treated with lifestyle modification on top of any other comorbidity treatment. However, for many patients with NAFLD, weight loss is hard to accomplish and/or sustain (e.g., patients may lack the skills, confidence, and motivation required to adhere to dietary changes, and/or may have problems limiting opportunities for increased physical activity). Therefore, tailored interventions which are manageable from the perspective of the individual patient with NAFLD could glean greater results. […] Accordingly, although there is a lack of research exploring the potential benefits of person-centered and compassion-based approaches to the management of NAFLD, in the present review, we draw on evidence from methods utilized in the treatment of other chronic conditions in postulating the view that such approaches might prove beneficial in the future management of NAFLD.

• #41 Challenges in the Management of Non-Alcoholic Fatty Liver Disease (NAFLD): Towards a Compassionate Approach

  https://www.mdpi.com/2673-4389/3/3/31

  Overall, as NAFLD represents a complex chronic disorder, a multidisciplinary and compassionate approach could aid attempts to overcome some of the challenges faced by both patients and PCPs when managing this condition. Some suggested behavioral interventions include peer support, counseling, and self-monitoring. Furthermore, the involvement of specialists such as dietitians and psychologists in addition to PCPs can prove crucial in ensuring that each individual patient with NAFLD receives adequate support. […] Compassionate approaches can aid recovery, help to relieve anxiety, alter the stress response, and have a positive effect on brain function and heart rhythm for both the recipient and the provider. […] Given the issues that individuals with NAFLD may face (e.g., self-management issues and potential lack of sufficient NAFLD knowledge) and based on the success of compassion-related approaches to other disorders linked to NAFLD, it is probable that such an approach could benefit individuals with NAFLD, and help to address the challenges encountered.

• #42 Challenges in the Management of Non-Alcoholic Fatty Liver Disease (NAFLD): Towards a Compassionate Approach

  https://www.mdpi.com/2673-4389/3/3/31

  Diagnosis and treatment of NAFLD frequently take place in the primary care setting, but certain issues have been raised regarding PCP’s lack of sufficient understanding of the condition, lack of confidence in diagnosis, and inconsistency in approaches to management. Some of these issues can potentially be addressed by the introduction of educational programs and multidisciplinary care pathways. […] However, due to the known difficulties that patients may encounter regarding lifestyle modification, the addition of a compassionate and empathetic approach in NAFLD care pathways could prove a significant aid in improving the holistic management of NAFLD. It could be argued that although lifestyle modification is an essential tool for treating NAFLD, healthcare providers should perhaps keep in mind that “caring and compassion were once often the only ‘treatment’ available to clinicians.” This is still relevant within the modern NAFLD care pathways, since although PCPs should offer integrated patient-orientated care, the conditions within which they operate may not always be supportive, and although advances in medical science provide new options, such advances may unintentionally distance PCPs from their patients.

• #43 Non-alcoholic fatty liver disease: A patient guideline

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8514420/

  It is important to note that NAFLD is not caused by alcohol, although high alcohol consumption can worsen the problem. […] It is important to stay within the guidelines, not only for your liver health but especially if you are trying to lose weight, as alcoholic drinks contain many empty calories, which have no nutritional value. […] Despite intensive research and investment by drug companies, there are currently no drugs specifically approved by regulatory agencies for the treatment of NAFLD. […] In general, all metabolic factors surrounding NAFLD, and NAFLD itself, contribute to an increased risk of dying from several different causes. CVD and cancers are the most frequent causes of death, adding to liver disease-related events. […] It is still unclear whether all patients with NAFLD are at risk for all these serious problems, or if these complications are mainly restricted to patients with NASH.

• #44

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ad1651

  Non-alcoholic fatty liver disease (NAFLD) is the term for conditions in which fat builds up in the liver in people who drink little or no alcohol. […] Most people who have NAFLD also have one or more of these health problems. But some have none of these other conditions. […] Treatment focuses on managing related conditions like diabetes and making lifestyle changes, including losing weight if needed, eating a healthy diet, and being more active. […] Follow-up care is a key part of your treatment and safety. […] Lose weight if you need to. Losing even 5% of your weight can make a difference to your health. […] Manage other health problems. These may include diabetes, high blood pressure, and high cholesterol. […] Eat healthy foods. This includes vegetables, fruits, nuts, beans, lean meat, fish, and whole grains.

• #45 Nonalcoholic fatty liver disease: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007657.htm

  Nonalcoholic fatty liver disease (NAFLD) is the buildup of fat in the liver that is not caused by drinking too much alcohol. People who have it do not have a history of heavy drinking. NAFLD is usually but not always related to being overweight. […] There is no specific treatment for NAFLD. The goal is to manage your risk factors and any health conditions. […] Your provider will help you understand your condition and the healthy choices that can help you take care of your liver. These may include: Losing weight if you are overweight. Eating a healthy diet that is low in salt. Not drinking alcohol. Staying physically active. Managing health conditions such as diabetes and high blood pressure. Getting vaccinated for diseases such as hepatitis A and hepatitis B. Lowering your cholesterol and triglyceride levels. Taking medicines as directed. Talk to your provider about all medicines you take, including herbs and supplements and over-the-counter medicines.

• #46 Nonalcoholic Fatty Liver Disease

  https://www.todaysdietitian.com/newarchives/010614p48.shtml

  RDs are the cornerstone of NAFLD treatment and should be up-to-date on the current recommendations for medical nutrition therapy. Nutrition professionals should work with patients health care team members, including primary care physicians, hepatologists, exercise physiologists, and health psychologists, to provide the best care. […] A nonpharmacological intervention based on personalized diet, physical activity, and behavior therapy should aim to encourage lifestyle change, the only therapy proven to effectively treat NAFLD. […] This continuing education course reviews the dietary factors associated with NAFLD as well as the lifestyle and nutrition options for treating the disease. […] Lifestyle modification through diet and exercise must be the first-line therapy of any treatment plan for patients with NAFLD. Available studies suggest that weight loss of 5% or more improves steatosis, and weight loss of 7% or more improves histological disease activity in NASH. […] In summary, weight loss, physical exercise, and dietary changes should be implemented on a long-term basis in all patients with NAFLD/NASH regardless of disease severity.

• #47

  https://link.springer.com/article/10.1007/s11606-021-07197-3

  Nonalcoholic fatty liver disease (NAFLD) is underdiagnosed in primary care despite a high prevalence (25%) and strong ties to metabolic syndrome. Advanced liver fibrosis from NAFLD is associated with poor outcomes, and non-invasive tests including the Fibrosis-4 Index (FIB-4), NAFLD Fibrosis Score (NFS), and AST-to-Platelet Ratio Index (APRI) can predict advanced fibrosis risk. […] Only 25% of this cohort received a NAFLD diagnosis and 917% of undiagnosed patients had high-risk advanced fibrosis scores. These findings emphasize the degree of NAFLD underdiagnosis in primary care and indicate that providers are missing advanced disease. […] These findings reinforce the need to improve NAFLD diagnosis in primary care, especially for patients at high risk for advanced fibrosis.

• #48 Non-alcoholic fatty liver disease: leading the fight in primary care | British Journal of General Practice

  https://bjgp.org/content/72/723/499

  The BSG, with representation from the Royal College of General Practitioners, have developed an algorithm for clinicians to use when determining the aetiology of liver pathology. […] Serum fibrosis markers should be used to rule out significant fibrosis. […] A FIB-4 score of 1.3 (2.0 if 65 years) or NFS 1.455 (0.120 if 65 years) indicates low risk of advanced fibrosis and can be managed in primary care. […] There is currently no approved treatment for NAFLD and the number of patients experiencing adverse liver outcomes is small, raising questions on the benefits of population screening until there are effective, evidence-based therapies available to prevent progression. […] NAFLD is primarily a metabolic disease, heavily influenced by lifestyle factors. GPs exposure to patients at risk is on an upward trajectory.

• #49 Non-alcoholic Fatty Liver Disease: Causes and Diagnoses

  https://patient.info/healthy-living/alcohol-and-liver-disease/non-alcoholic-fatty-liver-disease

  However, also remember that cardiovascular disease is the most common cause of illness and death in people with NAFLD. Perhaps the most important 'take home message’ if you are diagnosed with NAFLD is not to focus too much on your liver. Rather, concentrate on reducing any risk factors for developing cardiovascular problems. This is mainly lifestyle changes – in particular, diet, weight loss and exercise for most people and giving up smoking if you smoke.

• #50 Risk Prevention and Health Promotion for Non-Alcoholic Fatty Liver Diseases (NAFLD)

  https://www.mdpi.com/2673-4389/2/4/22

  Patients with NAFLD require close follow-up to screen for risk factors associated with the development of liver cirrhosis and liver fibrosis. […] Early detection of liver cirrhosis and liver fibrosis may decrease long-term complications and reduce mortality and morbidity in this patient population. […] Maintaining a healthy weight has been shown to benefit patient outcomes, and the current cornerstone of NAFLD therapy is weight loss and dietary interventions. […] The FDA has yet to approve a pharmacological therapy for NAFLD or NASH. […] The 2022 umbrella review of NAFLD treatments also noted that Huo Xue Hua Yu (HXHY) therapy, bicyclol, and silymarin improved liver function compared with the placebo, with HXHY being the most effective pharmacological intervention based on one meta-analysis. […] While NAFLD already affects 25% of adults globally, it is the fastest growing cause of liver mortality.

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