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Management of NAFLD in primary care settings

Abstract: Non-alcoholic fatty liver disease (NAFLD) affects at least 25% of the general population and is an increasingly important cause of cirrhosis and hepatocellular carcinoma. Although it is the research focus of the hepatology field, it is clear that primary care physicians are seeing the majority of NAFLD patients and are in a pivotal position to provide quality care. In this article, we review the role of primary care in the management of NAFLD. NAFLD is common in patients with diabetes, obesity and other metabolic risk factors. Abdominal ultrasonography is the most commonly used method to diagnose fatty liver. Simple fibrosis scores have high negative predictive values in excluding advanced liver fibrosis and future liver-related events and can be used in primary care as initial evaluation. An abnormal result should be followed by subsequent workup or specialist referral. Primary care is the ideal setting to institute multidisciplinary care, especially the involvement of dietitians and physical activity trainers in lifestyle intervention, as well as initiating the discussion of bariatric surgery in patients with severe obesity. Although specific drug treatment for steatohepatitis would require a more precise diagnosis, metabolic drugs that improve both steatohepatitis and cardiovascular outcomes (e.g. glucagon-like peptide-1 receptor agonists) may be considered in patients with NAFLD.

 Fuente: Liver Int . 2022 Nov;42(11):2377-2389

 Editorial: Wiley-Blackwell

 Año de publicación: 2022

 Nº de páginas: 13

 Tipo de publicación: Artículo de Revista

 DOI: 10.1111/liv.15404

 ISSN: 1478-3223,1478-3231

 Url de la publicación: https://www.doi.org/10.1111/liv.15404

Autoría

WONG, VINCENT W S

ZELBER-SAGI, SHIRA

CUSI, KENNETH

CARRIERI, PATRIZIA

WRIGHT, EUGENE

JAVIER CRESPO GARCIA

LAZARUS, JEFFREY V