NAFLD

Question 1

Diagnostic criteria of NAFLD

Answer 1

1) Evidence of hepatic steatosis eitehr by imaging or histology
+
2) lack of secondary causes of hepatic fat accumulation such as significant alcohol consumption, use of steatogenic medication or monogenic hereditary disorders

Presence of HS + no significant alcohol consumption, no competing etiologies for hepatosteatosis, no existing causes of chronic liver disease

**significant alcohol consumption = >21 drinks for men and >14 drinks for women in a week

Pt with NAFLD may present with elevated serum ferritin and autoimmune antibodies

Question 2

Differentiate NAFLD with NAFL and NASH, and what are they?

Answer 2

NAFL - non-alcoholic fatty liver > minimal inflammation/hepatocellular injury with low risk of progression to liver cirrhosis or hepatocarcinoma

NASH - non-alcoholic steatohepatitis > inflammation and hepatocellular injury with risk of progression to liver cirrhosis or hepatocarcinoma

NAFLD - category name of the above 2 diseases

Question 3

Risk factors for NAFLD

Answer 3

T2DM, dyslipidemia, metabolic syndrome, polycystic ovary syndrome, obesity

Associated - hypothyroidism, OSA, hypopituitarism, hypogonadism, pancreatoduodenal resection, psoriasis

Question 4

Management of NAFLD

Answer 4

Lifestyle modification - hypocaloric diet and exercise, avoid alcohol
Aggressive modification of CVS risk factors - treat dyslipidemia