Nonalcoholic fatty liver disease: Diagnosis and management

Jeff T Wilkins, Altaf Tadkod, Iryna Hepburn, Robert R. Schade

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Nonalcoholic fatty liver disease is characterized by excessive fat accumulation in the liver (hepatic steatosis). Nonalcoholic steatohepatitis is characterized by steatosis, liver cell injury, and inflammation. The mechanism of nonalcoholic fatty liver disease is unknown but involves the development of insulin resistance, steatosis, inflammatory cytokines, and oxidative stress. Nonalcoholic fatty liver disease is associated with physical inactivity, obesity, and metabolic syndrome. Screening is not recommended in the general population. The diagnosis is usually made after an incidental discovery of unexplained elevation of liver enzyme levels or when steatosis is noted on imaging (e.g., ultrasonography). Patients are often asymptomatic and the physical examination is often unremarkable. No single laboratory test is diagnostic, but tests of liver function, tests for metabolic syndrome, and tests to exclude other causes of abnormal liver enzyme levels are routinely performed. Imaging studies, such as ultrasonography, computed tomography, and magnetic resonance imaging, can assess hepatic fat, measure liver and spleen size, and exclude other diseases. Liver biopsy remains the criterion standard for the diagnosis of nonalcoholic steatohepatitis. Noninvasive tests are available and may reduce the need for liver biopsy. A healthy diet, weight loss, and exercise are first-line therapeutic measures to reduce insulin resistance. There is insufficient evidence to support bariatric surgery, metformin, thiazolidinediones, bile acids, or antioxidant supplements for the treatment of nonalcoholic fatty liver disease. The long-term prognosis is not associated with an increased risk of all-cause mortality, cardiovascular disease, cancer, or liver disease.

Original languageEnglish (US)
Pages (from-to)35-42
Number of pages8
JournalAmerican Family Physician
Volume88
Issue number1
StatePublished - Jul 1 2013

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Disease Management
Liver
Fatty Liver
Insulin Resistance
Ultrasonography
Fats
Biopsy
Thiazolidinediones
Incidental Findings
Bariatric Surgery
Metformin
Liver Function Tests
Enzymes
Liver Neoplasms
Non-alcoholic Fatty Liver Disease
Bile Acids and Salts
Routine Diagnostic Tests
Physical Examination
Liver Diseases
Weight Loss

ASJC Scopus subject areas

  • Family Practice

Cite this

Wilkins, J. T., Tadkod, A., Hepburn, I., & Schade, R. R. (2013). Nonalcoholic fatty liver disease: Diagnosis and management. American Family Physician, 88(1), 35-42.

Nonalcoholic fatty liver disease : Diagnosis and management. / Wilkins, Jeff T; Tadkod, Altaf; Hepburn, Iryna; Schade, Robert R.

In: American Family Physician, Vol. 88, No. 1, 01.07.2013, p. 35-42.

Research output: Contribution to journalArticle

Wilkins, JT, Tadkod, A, Hepburn, I & Schade, RR 2013, 'Nonalcoholic fatty liver disease: Diagnosis and management', American Family Physician, vol. 88, no. 1, pp. 35-42.
Wilkins, Jeff T ; Tadkod, Altaf ; Hepburn, Iryna ; Schade, Robert R. / Nonalcoholic fatty liver disease : Diagnosis and management. In: American Family Physician. 2013 ; Vol. 88, No. 1. pp. 35-42.
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