Non-alcoholic fatty liver disease

Question 1

What are the stages of NAFLD and NASH?

Answer 1

F0-1 = steatosis = NASH no fibrosis
F2 + F3 = NASH - increasing fibrosis
F4 = NASH and fibrosis = cirrhosis

Question 2

What are some of the health select committee recommendations to help reduce obesity in the UK?

Answer 2

strong control on price promotions of unhealthy foods
tougher controls on marktetting 
reduce sugar in food and drink 
sugar tax 
labelling of foods 
universal school food standards

Question 3

What does fibrosis predict?

Answer 3

predicts mortality in patients with NAFLD

= INCREASED FIBROSIS = INCREASED MORTALITY

Question 4

What is the treatment pyramid for NASH treatment?

Answer 4

1) Lifestyle modifications
2) Targeting components of metabolic syndrome
3) liver - directed pharmacotherapy
4) managing complications of cirrhosis

Question 5

How do you identify pts with fibrosis ?

Answer 5

Bloods
- AST/ALT ratio 
- AST to platelet ratio index
- BARD
- FIB-4
- NAFLD fibrosis score
ELF score
- <7.7 - none to mild
- 7.7-9.8= moderate
- >9.8 =severe 
imaging

Question 6

What improved fibrosis in NASH?

Answer 6

Weight loss through life-style modifications