Detection of NAFLD/NASH in the general population and in primary care clinics

Maya Margalit, Hanny Yeshua, Neta Gotlieb, Shira Zelber-Sagi

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Nonalcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver disorder, affecting approximately 25% of the population globally. The association of NAFLD with metabolic morbidity and cardiovascular disease (CVD), as well as its association with significant liver-related morbidity and mortality, create important challenges for primary care physicians in relation to the prevention, diagnosis and treatment of NAFLD and its associated risks for CVD and liver-related morbidity [1]. The importance of establishing a policy in regards to early detection of NAFLD and advanced fibrosis in primary care settings or diabetes clinics, among people with obesity, diabetes or the metabolic syndrome, who represent high-risk populations for the more advanced forms of NAFLD, is increasingly recognized. As most NAFLD patients in primary care settings have simple steatosis (NAFL), and are not at increased risk for liver-related morbidity, it is extremely important to provide physicians who see NAFLD patients in primary care settings and diabetes clinics with tools to identify patients at high liver-related risk, who will benefit from specialist care. The implementation of predictive models for risk stratification may change the landscape of early detection in non-specialist clinical settings. From a public health perspective, primary prevention policies and actions may be implemented for subjects categorized as being at high risk according to these models. Some of the tools incur minimal additional costs, being based on readily available lab tests, and can be calculated automatically in computerized medical systems. Their availability can be harnessed as a tool to increase awareness among general practitioners, diabetologists and the public to promote early diagnosis and appropriate management. Although, as for now, there are no approved drugs for NASH, and treatment focuses mainly on lifestyle modification, awareness may increase motivation among patients to improve their lifestyle, and intensify monitoring for liver-related (e.g. occult cirrhosis, hepatocellular carcinoma) and cardiovascular risks by physicians following the patient. With the advent of pharmaceutical treatments for NASH, which are expected in the near future, low cost, readily available prediction models will assist in identifying suitable patients for treatment.

Original languageEnglish
Title of host publicationNAFLD and NASH
Subtitle of host publicationBiomarkers in Detection, Diagnosis and Monitoring
EditorsM. Romero-Gomez
PublisherSpringer International Publishing
Pages11-27
Number of pages17
ISBN (Electronic)9783030371739
ISBN (Print)9783030371722
DOIs
StatePublished - 1 Jan 2020

Bibliographical note

Publisher Copyright:
© Springer Nature Switzerland AG 2020.

ASJC Scopus subject areas

  • Medicine (all)
  • Biochemistry, Genetics and Molecular Biology (all)

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