Fatty Liver Disease Article

Question 1

Classification of fatty liver disease

Answer 1

MAFLD and alcohol related.

MAFLD - metabolic dysregulation. 1 in 5-10 develop fibrosis.

Question 2

Major risk factors for MAFLD

Answer 2

Central adiposity
Obesity
Insulin resistance
T2DM
Metabolic syndrome
Hypertension
High calorie, high sat fat, chol and fructose
Sedentary lifestyle
Sarcopenia

Question 3

MAFLD facts

Answer 3

40% have normal BMI
Can coexist with alcohol related or viral hepatitis
Low intake of ETHO is asso with high risk of cirrhosis in MAFLD

Question 4

Diagnosis MAFLD

Answer 4

Screening for if T2DM or metabolic risk abnormalities, even if lean.

USS - hepatic stetosis >5% -> no significant alcohol use -> overwieght or T2DM or 2 metabolic risk abnormalities = MAFLD

Metsbolic risk abnormailities - waist, BP, TC, HDL, pre-diabetes, insulin resistance, CRP>2

Elastography more sensitive, as USS usually doesnt pick much up <20% steatosis

Question 5

How to stage fibrosis

Answer 5

NAFLD fibrosis score
Fibrosis -4
Elastography

Question 6

Management MAFLD

Answer 6

Management of metabolic dysregulation - diet, weight loss, exercise
Referral generally not required.

> 10% weight loss has been shown to reduce fat burden and fibrosis

There is no specific dietary approach.

Exercise is dose dependent, there is no specific regime.

No specific medication.
GLP-1, and bariatric surgery maybe.

Question 7

Long term monitoring

Answer 7

No accepted consensus

Stable metabolic factors - 2-3 year monitoring with scores and elastography.

Consider referral if stage 2-4 fibrosis - specialist lead monitoring.

Cirrhosis - 6 monthly surveillance for HCC - USS, AFP.
Endoscopy, esp plt <150
Watch BMD.