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Abstract Details
Nonalcoholic Fatty Liver Disease: An Important Consideration for Primary Care Providers in Hawai
Hawaii J Health Soc Welf. 2020 Jun 1;79(6):180-186.
Robert J Pattison1, James Phillip Esteban2, Tomoki Sempokuya3, Jakrin Kewcharoen1, Sumodh Kalathil4, Scott K Kuwada5
Author information
1Internal Medicine Residency Program, John A. Burns School of Medicine University of Hawai'i, Honolulu, HI (RJP, JK).
2Icahn School of Medicine at Mount Sinai, New York, NY (JPE).
3University of Nebraska Medical Center, Omaha NE (TS).
4Queens Medical Center Liver Center, Honolulu, HI (SCK).
5John A. Burns School of Medicine University of Hawai'i, Honolulu, HI (SKK).
Free PMC article
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. NAFLD is a broad term for both non-alcoholic fatty liver (NAFL), which describes simple fatty liver without inflammation, and non-alcoholic steatohepatitis (NASH), the more severe phenotype with hepatocellular inflammation. The population of Hawai'i is particularly vulnerable to the NAFLD and obesity epidemics due to its large proportions of high-risk ethnic minorities exposed to varying degrees of westernization. Unfortunately, primary care providers (PCPs) often face a lack of awareness on the diagnosis and disease spectrum of NAFLD. Early initiation of treatment for NAFLD is crucial to slow its progression and prevent liver-related morbidity and mortality. This review aims to raise awareness for NAFLD among PCPs in Hawai'i by summarizing the disease's epidemiology, diagnosis, and treatment. The diagnostic workup of NAFLD in the primary care setting involves exclusion of other liver disease etiologies and staging assessment of fibrosis and steatosis through non-invasive means such as serum biomarkers or elastography. Patients with overt signs and symptoms of cirrhosis or a high likelihood of advanced hepatic fibrosis should be referred to liver disease specialists. The role of PCPs in NAFLD management involves facilitating weight loss through therapeutic lifestyle modifications and treatment of comorbid cardiovascular conditions. Evidence-based pharmacologic therapies for NAFLD are available, such as vitamin E and pioglitazone, with more currently in development.