{"id":381807,"date":"2024-07-08T14:00:00","date_gmt":"2024-07-08T12:00:00","guid":{"rendered":"https:\/\/medizinonline.com\/?p=381807"},"modified":"2024-06-26T14:11:55","modified_gmt":"2024-06-26T12:11:55","slug":"screening-at-risk-patients-for-nafld","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/screening-at-risk-patients-for-nafld\/","title":{"rendered":"Screening at-risk patients for NAFLD"},"content":{"rendered":"\n

Non-alcoholic fatty liver disease (NAFLD) is the predominant cause of chronic liver disease. The FIB-4 score can be used to identify at-risk patients with NAFLD and, if necessary, refer them for further hepatologic evaluation. It is a simple and cost-effective screening method that is suitable for the primary care setting.<\/strong><\/p>\n\n\n\n

While screening the general population for NAFLD cannot be recommended, it is advised to screen at-risk patients – especially those with type 2 diabetes, metabolic syndrome, BMI >30 kg\/m\u00b2 or arterial hypertension – for the presence of NAFLD, particularly if elevated transaminases are present [1,2]. In the vast majority of cases (approx. 90%), NAFLD develops on the basis of a metabolic syndrome. NAFLD patients usually have central obesity and other components of a metabolic syndrome. Due to the serious consequences of progressive liver fibrosis and the frequency of NAFLD, a screening method that makes economic sense and is easy to implement is of great importance.<\/p>\n\n

Risk of carcinoma is increased with advanced fibrosis<\/h3>\n\n

The extent of developing liver fibrosis is the most important risk factor for NAFLD-related morbidity and mortality. Further structural remodeling of the liver tissue can lead to the development of liver fibrosis or cirrhosis, the stage of which is decisive for the prognosis [1\u20133]. Due to the increased risk of hepatocellular carcinoma (HCC) and, less frequently, intrahepatic cholangiocarcinoma, regular screening is recommended for NAFLD with advanced fibrosis according to the current s2k guideline [4\u20136]. The FIB-4 score is a non-invasive screening score that is used to identify risk constellations (advanced liver fibrosis). It is a simple and cost-effective method based on standard laboratory parameters. The FIB-4 score can be calculated automatically from the routine laboratory data ALAT, ASAT and thrombocytes. Due to its ease of implementation, it is a suitable tool for identifying at-risk patients with NAFLD in primary care. This is emphasized in the current version of the S2k guideline on NAFLD [1]. If inflammatory characteristics are added to NAFLD, steatohepatitis (NASH, non-alcoholic steatohepatitis) can develop. NASH is one of the leading etiologic factors for HCC and the diagnosis latency is a prognostically relevant factor [7]. It is recommended that patients with liver cirrhosis be screened every 6 months using imaging to detect carcinoma at a treatable stage [8].<\/p>\n

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Treat underlying diseases or comorbidities<\/h3>\n\n

There is currently no medication approved for the indication NAFLD. However, there are approved drugs for numerous typical concomitant diseases of NAFLD – such as type 2 diabetes, obesity, lipometabolic disorders – some of which have beneficial effects on NAFLD. Therefore, clear drug recommendations can be given for NAFLD depending on comorbidities and fibrosis stages. For example, glucagon-like peptide 1 (GLP1) receptor agonists have been shown to have beneficial effects on NAFLD in patients with type 2 diabetes (in combination with metformin) or obesity (as monotherapy) [9]. In obesity, bariatric surgery has also shown favorable long-term effects on both liver-associated and extrahepatic morbidity and mortality in NAFLD [10]. However, the guideline points out that metabolic surgery should not be performed on obese NAFLD patients with decompensated cirrhosis and\/or portal hypertension [1].<\/p>\n

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Lifestyle modification as an important component<\/h3>\n\n

The lifestyle recommendations are propagated in the current NAFLD guideline as an important basis for any NAFLD treatment. Specific recommendations for NAFLD\/NASH include [1,2,11]\n\n