Non-alcoholic fatty liver disease: management in primary health care
DOI:
https://doi.org/10.32385/rpmgf.v41i5.13828Keywords:
Non-alcoholic fatty liver disease, Metabolic-associated fatty liver disease, Hepatic steatosis, Primary health careAbstract
Introduction: Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming a developed world epidemic. Although its pathogenesis is not fully understood, obesity and type 2 diabetes mellitus are recognized as the main risk factors.
Aims: Review of concepts relative to the spectrum of NAFLD, its epidemiology, and natural history. Analysis of recommendations regarding screening indications, diagnostic means, and non-invasive measurement of the degree of fibrosis, as well as follow-up and treatment guidelines of patients with this condition, meeting the primary health care (PHC) reality.
Methods: Research of scientific articles in online evidence-based medicine platforms using the keywords Nonalcoholic Fatty Liver Disease and Primary Health Care. The search was carried out in February 2023, and articles published from 2019 onwards were included. Selection was based on the title, abstract content, and publication date. Additionally, guidelines from the main international scientific societies involved in the management of NAFLD were consulted.
Results: NAFLD encompasses a wide spectrum of disease, whose progression is not linear, but potentially dynamic. With a prevalence of around 25% alone, and which increases considerably before certain risk factors, it is currently the main cause of chronic liver disease. Although the main cause of death is cardiovascular disease, advanced liver fibrosis is a prognostic marker for liver outcomes and mortality, with validated non-invasive fibrosis risk assessment scores. In addition to being able to be used in the initial assessment and monitoring of patients within the scope of CSP, they also allow identifying which ones will benefit from hospital referral.
Conclusion: Primary health care is the front line in the prevention, identification, assessment, and monitoring of individuals with NAFLD and their comorbidities. Early diagnosis, with determination of fibrosis risk, is critical in preventing disease progression and improving outcomes.
Downloads
References
1. Basu R, Noureddin M, Clark JM. Nonalcoholic fatty liver disease: review of management for primary care providers. Mayo Clin Proc. 2022;97(9):1700-16.
2. Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. Lancet. 2021;397(10290):2212-24.
3. Wong VW, Zelber-Sagi S, Cusi K, Carrieri P, Wright E, Crespo J, et al. Management of NAFLD in primary care settings. Liver Int. 2022;42(11):2377-89.
4. Younossi ZM, Corey KE, Alkhouri N, Noureddin M, Jacobson I, Lam B, et al. Clinical assessment for high-risk patients with non-alcoholic fatty liver disease in primary care and diabetology practices. Aliment Pharmacol Ther. 2020;52(3):513-26.
5. McPherson S, Armstrong MJ, Cobbold JF, Corless L, Anstee QM, Aspinall RJ, et al. Quality standards for the management of non-alcoholic fatty liver disease (NAFLD): consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD Special Interest Group. Lancet Gastroenterol Hepatol. 2022;7(8):755-69.
6. European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity. EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-402.
7. Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, et al. American Association of Clinical Endocrinology Clinical Practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28(5):528-62.
8. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.
9. Aller R, Fernández-Rodríguez C, Lo Iacono O, Bañares R, Abad J, Carrión JA, et al. Consensus document – Management of non-alcoholic fatty liver disease (NAFLD): clinical practice guideline. Gastroenterol Hepatol. 2018;41(5):328-49. English, Spanish
10. Budd J, Cusi K. Nonalcoholic fatty liver disease: what does the primary care physician need to know? Am J Med. 2020;133(5):536-43.
11. Nielsen EM, Anderson KP, Marsden J, Zhang J, Schreiner AD. Nonalcoholic fatty liver disease underdiagnosis in primary care: what are we missing? J Gen Intern Med. 2022;37(10):2587-90.
12. Chadha N, Sterling RK. Bridging the gap: screening for nonalcoholic fatty liver disease in the primary care population. Clin Gastroenterol Hepatol. 2022;20(11):2448-50.
13. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 2. Classification and diagnosis of diabetes: standards of care in diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S19-40.
14. Kumar S, Wong R, Newberry C, Yeung M, Peña JM, Sharaiha RZ. Multidisciplinary clinic models: a paradigm of care for management of NAFLD. Hepatology. 2021;74(6):3472-8.
15. National Institute for Health and Care Excellence. Non-alcoholic fatty liver disease: assessment and management. London: NICE; 2016.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
