Effective screening, diagnosis, and management strategies are needed for patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), according to a special report published online July 26 in Gastroenterology.
Fasiha Kanwal, M.D., from Baylor College of Medicine in Houston, and colleagues reviewed and discussed the literature on global burden, screening, risk stratification, diagnosis, and management of individuals with NAFLD, including those with NASH, to develop guidelines for NAFLD/NASH care.
The authors note that the clinical burden of NAFLD and NASH has increased steadily; NAFLD currently affects 25 percent of the global population and >60 percent of patients with type 2 diabetes. Recommendations include the need to develop more sensitive and specific diagnostic methods for NASH due to the invasive nature and relatively high expense of liver biopsy. Multidisciplinary, team-based care is crucial when NAFLD progresses to NASH; developing and validating algorithmic approaches, as well as connectivity and multidirectional referrals, is necessary to improve the traditional model of primary, secondary, and tertiary care. Clinical care pathways using validated and efficient noninvasive tests and calculators are crucial for a multidisciplinary approach to NAFLD/NASH management. The public health response to NAFLD is limited, and intersociety collaboration for harmonizing guidelines to optimize screening, diagnosis, and management is needed.
“The upward trend in NAFLD/NASH incidence and prevalence underscores the importance and urgency of developing and implementing effective screening, diagnosis, and treatment strategies in the United States and globally, particularly among emerging at-risk cohorts, such as patients with diabetes and obesity,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.