Fatty liver and diabetes: Management in the year 2019

06. 11. 2019

Fatty liver and diabetes: Management in the year 2019

Non-alcoholic fatty liver disease (NAFLD), or fatty liver disease to a layperson, has been increasingly recognised as a cause of liver morbidity and mortality. Local studies have shown that the incidence is as high as 40% and is related to the increasing prevalence of metabolic diseases (diabetes, obesity, hyperlipidemia) as well as sedentary lifestyle.

NAFLD may progress to a more severe condition (steatohepatitis), and without intervention this may further progress to liver fibrosis and cirrhosis (hardening of liver). Liver cirrhosis is an independent risk factor for the development of decompensated liver disease, liver cancer or even liver failure.

Patients with NAFLD may be completely asymptomatic although they sometimes present with abnormal liver function test (LFT). As such, patients with risk factors (obesity, diabetes, dyslipidemia) sometimes may be advised to undergo screening for early detection and intervention. Depending on the initial findings (history, clinical examination, liver function test, ultrasound of liver), additional investigations may need to be performed to rule out other conditions such as viral hepatitis, autoimmune hepatitis etc which may present similarly or even co-exist with NAFLD.

Treatment of NALFD generally depends on the severity and investigation findings. For example, patients with early NAFLD usually requires intensive lifestyle changes (weight loss, regular exercises, healthy eating habits) as well as close control of co-existing diseases related to NALFD (diabetes, hyperlipidemia etc). Medical therapy (such as vitamin E) may be necessary in patients with steatohepatitis.

Close working relationship between primary care doctors (GPs, Family Physicians) and hepatologist / gastroenterologist is essential for successful outcome in management of NAFLD patients. Uncomplicated NAFLD cases are usually managed by primary care doctors who can follow-up patients’ chronic medical conditions as well. In advanced stages of NAFLD (e.g. fibrosis, cirrhosis, steatohepatitis), co-management with a hepatologist / gastroenterologist should be considered for better patient outcome.

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