There are two key challenges when considering a NASH diagnosis. The first involves identifying at-risk patients. The second involves determining the level of risk a patient is facing. Successfully identifying a patient’s current stage and their risk of progressing can help you make more confident diagnoses and treatment recommendations. The chart below offers some helpful guidelines.
MANAGING NASH1
NASH treatment is rapidly changing and new, more effective treatments are on the horizon.2 But for now, it will take awareness, vigilance, and careful risk-benefit analysis to change the lives of NASH and NAFLD patients.
Below are guidelines from the American Association for the Study of Liver Diseases (AASLD).3 While none of the treatment options below have been approved for the treatment of NASH, it may be a good place to start.
| AASLD Guidance Statements | |
|---|---|
| Lifestyle Intervention | Combination of hypocaloric diet and moderate-intensity exercise provide best likelihood of sustained weight loss.Weight loss of at least 3-5% body weight to improve steatosis.Weight loss of 7-10% to improve majority of histopathological features of NASH including fibrosis. |
| Metformin | Not recommended for treating NASH in adult patients |
| Pioglitazone | May be used to treat patients with and without T2DM with biopsy-proven NASH. Risks and benefits should be discussed.Should not be used to treat NAFLD without biopsy-proven NASH. |
| GLP-1 analogues | Premature to consider GLP-1 agonists to specifically treat liver disease in patients with NAFLD or NASH. |
| Vitamin E | May be used for nondiabetic adults with biopsy-proven NASH. Risks and benefits should be discussed.Not recommended to treat NASH in diabetic patients, NAFLD without liver biopsy, NASH cirrhosis or cryptogenic cirrhosis until further data supporting Vit E effectiveness become available. |
OFFICIAL GUIDELINES
American Association for the Study of Liver Disease (Last edition: 2018)
European Association for the Study of the Liver
(Last edition: 2016)
The European Society for Pediatric
Gastroenterology, Hepatology and Nutrition
(Last edition: 2012)
North American Society for Pediatric Gastroenterology Hepatology and Nutrition
(Last edition: 2017)
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References
- Rinella ME, Sanyal AJ. Management of NAFLD: a stage-based approach. Nature. 2016;13:196-205.
- Sumida Y, Yoneda M. Current and future pharmacological therapies for NAFLD/NASH. J Gastroenterol. 2018;53(3):362-376.
- Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005-2023.
