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. 2021 Dec;60(Suppl 2):36-52.
doi: 10.20471/acc.2021.60.s1.03.

CROATIAN GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE

Lucija Virović Jukić  1   2   3 , Ivica Grgurević  1   3   4   5 , Ivana Mikolašević  3   6   7 , Tajana Filipec Kanižaj  1   3   8 , Sandra Milić  3   6   7 , Anna Mrzljak  1   3   9 , Marina Premužić  3   9 , Irena Hrstić  3   6   10 , Ivana Knežević-Štromar  3   9 , Neven Ljubičić  1   2   3   11 , Rajko Ostojić  1   3   9 , Sanja Stojsavljević Shapeski  2   3 , Vjekoslava Amerl-Šakić  12   13 , Nina Bašić Marković  6   14   15 , Marko Rađa  16   17 , Dragan Soldo  1   18   19   20 , Nikola Sobočan  1   3   8 , Miloš Lalovac  3   8 , Željko Puljiz  3   21   22 , Kristian Podrug  3   22 , Dinko Ladić  3   23
Affiliations

CROATIAN GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE

Lucija Virović Jukić et al. Acta Clin Croat. 2021 Dec.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a term describing excessive accumulation of fat in hepatocytes, and is associated with metabolic syndrome and insulin resistance. NAFLD prevalence is on increase and goes in parallel with the increasing prevalence of metabolic syndrome and its components. That is why Croatian guidelines have been developed, which cover the screening protocol for patients with NAFLD risk factors, and the recommended diagnostic work-up and treatment of NAFLD patients. NAFLD screening should be done in patients with type 2 diabetes mellitus, or persons with two or more risk factors as part of metabolic screening, and is carried out by noninvasive laboratory and imaging methods used to detect fibrosis. Patient work-up should exclude the existence of other causes of liver injury and determine the stage of fibrosis as the most important factor in disease prognosis. Patients with initial stages of fibrosis continue to be monitored at the primary healthcare level with the management of metabolic risk factors, dietary measures, and increased physical activity. Patients with advanced fibrosis should be referred to a gastroenterologist/hepatologist for further treatment, monitoring, and detection and management of complications.

Keywords: Cirrhosis; Diagnostics; Fibrosis; Hepatocellular carcinoma; Metabolic syndrome; Nonalcoholic fatty liver disease (NAFLD); Nonalcoholic steatohepatitis (NASH); Noninvasive methods; Screening; Treatment.

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Figures

Fig. 1
Fig. 1
Clinical pathological spectrum of changes in nonalcoholic fatty liver disease (adapted from reference 1). NAFLD = nonalcoholic fatty liver disease; NAFL = steatosis or nonalcoholic fatty liver; NASH = nonalcoholic steatohepatitis; HCC = hepatocellular carcinoma; IR = insulin resistance
Fig. 2
Fig. 2
Diagnostic protocol for screening for nonalcoholic fatty liver disease in patients with metabolic risk factors (adapted from references 1, 13, 66, 71-73).
Fig. 3
Fig. 3
The basis of treatment for patients with nonalcoholic fatty liver disease is comprehensive lifestyle modification, while pharmacotherapy and surgical methods are indicated in a small portion of patients.
Fig. 4
Fig. 4
Modification of habits and lifestyle are the foundation of treatment for patients with nonalcoholic fatty liver disease.
See this image and copyright information in PMC

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