Alcohol and NAFLD

Question 1

What percentage of those that drink heavily

• develop fatty liver disease
• develop alcoholic hepatitis
• develop cirrhosis

Answer 1

90% develop fatty liver disease
30-35% develop alcoholic hepatitis
20% develop cirrhosis

Question 2

What are the two main mechanisms by which alcohol causes hepatotoxicity?

Answer 2

direct effects

activation of kupffer cells (pro-inflammatory and pro-fibrotic cytokines, activation of stellate cells)

Question 3

What dictates whether a person with alcoholic hepatitis gets prednisolone
what does this involve
what other interventions may be useful
what dictates the duration of treatment
what is the mortality rate at 6 months

Answer 3

Maddrey score >32
Prednisolone 40mg daily (or 32mg IV methylpred)
NAC may be useful
Duration of treatment dictated by Lillie score at day 7 - if >=0.45 patient has not improved with therapy and therefore should have pred ceased
20% mortality

Question 4

NAFLD
prevalence
% who develop cirrhosis
rank cause of end-stage liver disease
rank HCC
rank cause for liver transplantation

Answer 4

24% prevalence
<10% who develop cirrhosis
rank 2nd cause of end-stage liver disease
rank 2nd HCC
rank 3rd cause for liver transplantation

Question 5

NASH
prevalence
% of those with NAFLD
how it is diagnosed
scoring system on histology

Answer 5

1.5-6% prevalence
20% of those with NAFLD
diagnosed on biopsy diagnosed
scoring system on histology is NAFLD activity score (NAS)
- steatosis, inflammation, hepatocyte ballooning
- threshold for diagnosis >5

Question 6

NAFLD

• is AST or ALT higher
• can transaminases revert to normal with advancing fibrosis?

Answer 6

• ALT is usually higher

- yes

Question 7

Treatment of NAFLD

Answer 7

Weight loss
Possibly poiglitazone and vitamin E
Metformin improves insulin sensitivity but have no effect on liver related outcomes