Nonalcoholic Fatty Liver Disease: What Does the Primary Care Physician Need to Know?

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States and is soon to be the leading cause of liver transplantation. Patients at the greatest risk are those with obesity and type 2 diabetes mellitus. In 2019 the American Diabetes Association guidelines called, for the first time, for clinicians to screen for steatohepatitis and fibrosis all patients with type 2 diabetes and liver steatosis or abnormal plasma aminotransferases. This requires primary care physicians to be aware of key aspects related to the diagnosis and treatment of NAFLD, as well as to when to refer to a specialist. Unfortunately, there is still significant medical inertia as clinicians remain unaware of its high morbidity/mortality. Early diagnosis in the primary care setting is critical to prevent progression to end-stage liver disease. Patients with NAFLD are also at a higher risk of developing type 2 diabetes mellitus and cardiovascular disease. Despite general perception to the contrary, weight loss by lifestyle intervention or bariatric surgery and several pharmacological treatments (eg, vitamin E in nondiabetics, pioglitazone or glucagon-like peptide 1 receptor agonists in patients with or without diabetes) can often be successful to reverse steatohepatitis and prevent disease progression.

Keywords: Cirrhosis; Elastography; FIB-4; Glucagon-like peptide 1 receptor agonist; Hepatocellular carcinoma; Insulin resistance; Liver biopsy; Liver fat; NAFLD; NASH; Nonalcoholic steatohepatitis; Pioglitazone; SGLT2 inhibitor; Steatosis; Type 2 diabetes.