Managing nonalcoholic fatty liver disease: recommendations for family physicians.
OBJECTIVE
To review evidence on the diagnosis and management of nonalcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease in human beings.


METHODS
The literature was searched for clinical trials and review articles on NAFLD. Levels I and II evidence indicates the benefit of both lifestyle and pharmacologic interventions for NAFLD and nonalcoholic steatohepatitis (NASH).


RESULTS
Scientific evidence does not currently support systematic screening for NAFLD. Both NAFLD and NASH are frequently discovered in overweight and obese patients with asymptomatic elevation of serum aminotransferase levels. Ultrasonography detects the presence of a fatty liver, but is unreliable for detecting and quantifying liver fibrosis. Patients with NAFLD should be monitored for possible progression to NASH, particularly if they have diabetes or metabolic syndrome. Although diet and exercise are the mainstays of treatment, medication might be warranted if an appropriate diet and regular physical activity do not improve biochemical markers and liver morphology. Referral for liver biopsy and further evaluation should be considered for those at higher risk of developing NASH.


CONCLUSIONS
Although most patients with NAFLD have a benign course, some progress to NASH, liver cirrhosis, and hepatocellular carcinoma. These patients should be carefully monitored for progression of disease and treated for associated metabolic disturbances. An integrated approach to care is essential.
Grattagliano
Ignazio
I
Department of Internal Medicine and Public Medicine, University of Bari, P.zza G. Cesare, 11-70124 Bari, Italy. i.grattagliano@semeiotica.uniba.it
Portincasa
Piero
P
Palmieri
Vincenzo O
VO
Palasciano
Giuseppe
G
D000328:Adult; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D004032:Diet; D005194:Family Practice / Q000379:methods; D005234:Fatty Liver / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000517:prevention & control*; D008111:Liver Function Tests; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D019440:Anti-Obesity Agents; D000975:Antioxidants