NAFLD may progress to NASH. In the adult population of the U.S., the estimated prevalence of NAFLD is 30%, and that of NASH is 3% to 5%. It is estimated that 4% of patients with steatosis alone and 26% of patients with NASH progress to cirrhosis over a 10-year period. Obesity and diabetes mellitus type 2 are the major risk factors for NAFLD and NASH. In the presence of morbid obesity, the prevalence of NAFLD was greater than 90%, and that of NASH was greater than 30%.
Most patients with NAFLD are asymptomatic and some present with nonspecific symptoms such as fatigue.
The most common finding is elevated transaminases, with or without hepatomegaly.
Laboratory evaluation should include LFTs, fasting glucose, fasting lipid profile, and lab tests associated with advanced liver disease such as prothrombin time, platelet count, and albumin.
Exclude alternative clinical conditions associated with abnormal LFT results.
Consider liver biopsy for definitive diagnosis in selected patients who are at increased risk for fibrosis or NASH.
Counsel overweight and morbidly obese patients about diet, exercise, and weight loss surgery, although the evidence supporting these as treatments for NAFLD has been inconclusive.
Discuss with patients the limited effectiveness of most drug therapies for NAFLD, except possibly insulin sensitizers in some patients with diabetes.