Title:Nonalcoholic Fatty Liver Disease (NAFLD) for Primary Care Providers: Beyond the Liver
Volume: 17
Issue: 2
Author(s): Eddison Godinez-Leiva and Fernando Bril*
Affiliation:
- Division of Endocrinology, Diabetes and Metabolism, University of Alabama in Birmingham, Birmingham, AL 35233,United States
Keywords:
NAFLD, steatohepatitis, NASH, T2DM, insulin resistance, liver.
Abstract: Nonalcoholic fatty liver disease (NAFLD) has consolidated as a major public health
problem, affecting ~25% of the global population. This percentage is significantly higher in the setting
of obesity and/or type 2 diabetes. The presence of NAFLD is associated with severe liver complications,
such as nonalcoholic steatohepatitis (NASH; i.e., presence of inflammation and necrosis),
cirrhosis and hepatocellular carcinoma. However, the majority of these patients die of cardiovascular
disease. For this reason, management of this condition requires a multidisciplinary team,
where primary care providers are at center stage. However, important misconceptions remain
among primary care providers, preventing them from appropriately approach these patients. Nonalcoholic
fatty liver disease should be understood as part of a systemic disease characterized for abnormal
accumulation of fat in tissues other than the adipose tissue. This, in turn, produces dysfunction
of those organs or tissues (process sometimes referred to as lipotoxicity). Therefore, due to the
systemic nature of this condition, it should not surprise that NAFLD is closely related to other
metabolic conditions. This review will focus on the extrahepatic manifestations of NAFLD and its
metabolic and cardiovascular implications. We believe these are the most important issues primary
care providers should understand in order to effectively manage these complicated patients. In addition,
we have provided a simple and straightforward approach to the diagnosis and treatment of patients
with NAFLD and/or NASH. We hope this review will serve as a guide for primary care
providers to approach their patients with NAFLD.