NAFLD

Question 1

What can NAFLD increase the risk of (non-liver)?

Answer 1

Part of the “metabolic syndrome” group of chronic health conditions relating to processing and storing energy that increase risk of heart disease, stroke and diabetes.

Question 2

Stages of NAFLD?

Answer 2

1. Non-alcoholic Fatty Liver Disease
2. Non-Alcoholic Steatohepatitis (NASH)
3. Fibrosis
4. Cirrhosis

Question 3

Risk factors NAFLD

Answer 3

CV risk factors

Obesity
Poor diet and low activity
T2DM
Hypercholesterolaemia
Smoking
Hypertension

Question 4

How to investigate abnormal LFTs without clear cause?

Answer 4

Non-invasive liver screen:

• USS liver
• Hepatitis serology
• Autoantibody screen (autoimmune hepatitis, PBC, PSC)
• Immunoglobulins (autoimmune hepatitis, PBC)
• Caeruloplasmin (Wilsons)
• A1-antitrypsin levels (A1AD)
• Ferritin and transferrin saturation (hereditary haemochromatosis)

Question 5

Investigations in NAFLD

Answer 5

Liver ultrasound can confirm fatty liver but not whether there is fibrosis

ELF (Enhanced Liver Fibrosis) is first line for investigating fibrosis

NAFLD fibrosis score is second line if ELF not available

Fibroscan third line (performed if the ELF blood test or NAFLD fibrosis score indicates fibrosis)

Question 6

Management of NAFLD

Answer 6

Weight loss
Exercise
Stop smoking
Control of diabetes, blood pressure and cholesterol
Avoid alcohol

Fibrosis:

• Refer to liver specialist
• May treat with vitamin E or pioglitazone

Question 7

ELF (Enhanced Liver Fibrosis) score meaning

Answer 7

< 7.7 indicates none to mild fibrosis

≥ 7.7 to 9.8 indicates moderate fibrosis

≥ 9.8 indicates severe fibrosis