Management of NAFLD in primary care settings

Vincent W.S. Wong, Shira Zelber-Sagi, Kenneth Cusi, Patrizia Carrieri, Eugene Wright, Javier Crespo, Jeffrey V. Lazarus

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish
JournalLiver International
DOIs
StateAccepted/In press - 2022

Bibliographical note

Funding Information:
VW served as a consultant or advisory board member for AbbVie, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Inventiva, Merck, Novo Nordisk, Pfizer, ProSciento, Sagimet Biosciences and TARGET PharmaSolutions; and a speaker for Abbott, AbbVie, Echosens, Gilead Sciences and Novo Nordisk. He has received a grant from Gilead Sciences to support fatty liver research, and is a co‐founder of Illuminatio Medical Technology Limited. PC received research grants from MSD and Intercept. KC has received research support towards the University of Florida as principal investigator from Echosens, Inventiva, Novo Nordisk, Poxel, Labcorp and Zydus and is a consultant for Arrowhead, AstraZeneca, 89Bio, BMS, Lilly, Madrigal, Novo Nordisk, Quest, Sagimet, Sonic Incytes and Terns. EW served as an advisory board member, consultant and speaker for Abbott Diabetes Care, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Lilly and Sanofi. JC reports consultant and/or speaker and/or participated in clinical trials sponsored and/or received grants and research support from Gilead Sciences, AbbVie, MSD, Shionogi, Intercept Pharmaceuticals, Janssen Pharmaceuticals Inc, Celgene and Alexion (all outside the submitted work). JVL acknowledges grants and speaker fees from Gilead Sciences and MSD and speaker fees from AbbVie, Genfit, Intercept and ViiV, outside of the submitted work. JVL also acknowledges support to ISGlobal from the Spanish Ministry of Science, Innovation and Universities through the “Centro de Excelencia Severo Ochoa 2019‐2023” Programme (CEX2018‐000806‐S) and from the Government of Catalonia through the CERCA Programme. The other authors did not report any conflict of interest.

Publisher Copyright:
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Keywords

  • cirrhosis
  • general practice
  • liver fibrosis
  • non-alcoholic fatty liver disease
  • non-alcoholic steatohepatitis

ASJC Scopus subject areas

  • Hepatology

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