Comprehensive Management of NAFLD A Physician Perspective

Nonalcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver disease and it has become the leading cause of hepatocellular carcinoma and liver transplantation in recent time. In India, almost 38% of general population suffer from NAFLD. The prevalence is very high in people having metabolic disorder like obesity, type 2 diabetes, dyslipidemia. The route cause behind NAFLD and metabolic disorder is common and that is insulin resistance. NAFLD is an umbrella term and it encompasses simple steatosis (NAFL), NASH (inflammation and hepatocyte ballooning). Progression of disease will lead to significant development of fibrosis in liver which may lead to cirrhosis, HCC and mortality. Guidelines recommend the screening for NAFLD in all patients having risk factors like obesity, type 2 diabetes, dyslipidemia, metabolic syndrome etc. Initial screening may involve ultrasonography to detect steatosis, FIB-4 scoring to rule out significant/advance fibrosis. Transient elastography may also help in detecting the liver stiffness and steatosis in NAFLD patients. Lifestyle therapy including weight loss of 10%, dietary modification and physical exercise is the key in the management of NAFLD/NASH. In drug therapy, the recommended drugs are Vit E, Pioglitazone and Saroglitazar. Vit E is recommended in non diabetic NASH patients. Pioglitazone 30mg/d can also be recommended. Vit E may be associated with increased risk of hemorrhagic stroke and prostate cancer. Pioglitazone may lead in increase in body weight. Saroglitazar is the only drug approved in India by DCGI for the treatment of non-cirrhotic NASH and NAFLD with comorbidities. Saroglitazar may be preferred in NAFLD patients having diabetic dyslipidemia as it improves insulin sensitivity, atherogenic dyslipidemia and NAFLD/NASH parameters.