Author information
- 1Internal Medicine Department, Endocrinology Section, Yale University.
- 2Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA.
Abstract
Context: Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and type 2 diabetes (T2D), causing substantial burden from hepatic and extrahepatic complications. However, endocrinologists often follow people who are at the highest risk of its more severe form with nonalcoholic steatohepatitis or NASH (i.e., metabolic syndrome, prediabetes/T2D). Endocrinologists are in a unique position to prevent cirrhosis in this population with early diagnosis and treatment.
Objective: Offer endocrinologists a practical approach for the management of patients with NAFLD, including diagnosis, fibrosis risk-stratification and referral to hepatologists.
Cases: 1) an asymptomatic patient with obesity and cardiometabolic risk factors, found to have hepatic steatosis; 2) a patient with T2D and NASH with clinically significant liver fibrosis; and 3) a liver transplant recipient with a history of NASH cirrhosis, regaining weight and with recurrent NAFLD on transplanted organ.
Conclusions: NASH is reversible with treatment of obesity, calling for a broader use of structured weight-loss programs, obesity pharmacotherapy and bariatric surgery. While no drugs are FDA-approved for the treatment of NASH, diabetes medications such as pioglitazone and some glucagon-like peptide 1 receptor agonists, improve liver histology and cardiometabolic health. Sodium-glucose cotransporter-2 inhibitors and insulin may ameliorate steatosis, but their effect on steatohepatitis and fibrosis remains unclear. Awareness by endocrinologists about which are the high-risk groups, establishing an early diagnosis of fibrosis (i.e., FIB-4, liver elastography), long-term monitoring, and timely referral to the hepatologist within the care of a multidisciplinary team are all critical to curve the looming epidemic of cirrhosis from NAFLD upon us.