AGA — in collaboration with seven professional associations — convened an international conference of 32 experts to develop a multidisciplinary action plan to improve care for the growing population of patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). The recommendations from this meeting have been co-published in Gastroenterology along with three other leading journals: Diabetes Care, Metabolism: Clinical and Experimental and Obesity: The Journal of the Obesity Society.
Key findings from this special report:
- Patients with obesity or type 2 diabetes are at a higher risk of developing NAFLD/NASH with diabetes being a major risk factor for worse disease severity and progression to cirrhosis (permanent damage to the liver).
- Primary care providers are critical to managing this growing epidemic. They should be the first line for screening patients at risk, stratifying patients based on their risk for advanced fibrosis, and providing effective management and referrals.
- The guiding principle for risk stratification is to rule out advanced fibrosis by simple, noninvasive fibrosis scores (such as NAFLD fibrosis score or Fibrosis-4 Index). Patients at intermediate or high risk may require further assessment with a second-line test — elastography, or a serum marker test with direct measures of fibrogenesis.
- Because NAFLD is not an isolated disease but a component of cardiometabolic abnormalities typically associated with obesity, insulin resistance and type 2 diabetes, the cornerstone of therapy is lifestyle-based therapies (altered diet, such as reduced-calorie or Mediterranean diet and regular, moderate physical activity), and replacing obesogenic medications to decrease body weight and improve cardiometabolic health. Patients with diabetes who also have NASH may benefit from certain antidiabetic medications (i.e, pioglitazone, semaglutide) that treat not only their diabetes, but that also reverse steatohepatitis and improve cardiometabolic health.
- Optimal care of patients with NAFLD and NASH requires collaboration among primary care providers, endocrinologists, diabetologists, obesity medicine specialists, gastroenterologists and hepatologists, to tackle both the liver manifestations of the disease and the comorbid metabolic syndrome and cardiovascular risk, as well as screening and treating other comorbid conditions (e.g., obstructive sleep apnea).