Non-Alcoholic Fatty Liver Disease

Question 1

What is it?

Answer 1

Term for a range of conditions caused by a build-up of fat in the liver (umbrella term encompassing three entities)

• Simple steatosis (NAFLD): 25-40% of the population develop
• Non-alcoholic steatohepatitis (NASH) (fat causing inflammation): 1/4 develop cirrhosis
• Fibrosis and cirrhosis

Question 2

What are the risk factors?

Answer 2

Diabetes mellitus
Obesity
Hyper-triglyceridaemia
Hypertension
Hyper-cholesterolaemia
Age
Ethnicity
Genetic factors
(alcohol)

Question 3

What is significant about the risk factors?

Answer 3

Due to risk factors, patients commonly die of heart attacks/strokes etc (increased CV risk)

Question 4

What is the presentation of steatohepatitis?

Answer 4

Asymptomatic
Raised alanine aminotransferase
Fatty liver on USS
Liver biopsy

Question 5

What is the treatment of steatohepatitis?

Answer 5

Weight loss
Exercise
Stop/reduce alcohol

Question 6

How is NAFLD diagnosed?

Answer 6

Biochemical tests: AST/ALT ratio
Enhanced liver fibrosis panel (ELF): hyaluronic acid, TIMP-1, and PIIINP
Cytokeratin-18
Ultrasound
Fibroscan
MR/CT
MR Spectroscopy: actually quantify fat
Liver biopsy
NAFLD score

Question 7

What are the treatment options?

Answer 7

• Diet and weight reduction
• Exercise
• Insulin sensitizers e.g. Metformin, Pioglitazone
• Glucagon-like peptide-1 (GLP-1) analogues e.g. Liraglutide
• Farnesoid X nuclear receptor ligand e.g. Obeticholic acid
• Vitamin E
• Weight reduction surgeries

Question 8

What are the complications?

Answer 8

Cirrhosis