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Weight change as a key therapeutic option
Given the above findings, it is clear that alteration in weight trajectory, and ideally some weight loss, is
a key facet of the management of NAFLD but how to best achieve this is often unclear. Nevertheless,
there is plentiful evidence that weight loss lessens risk of T2DM and improves liver fat levels in parallel
with improvements in hepatic insulin resistance. A recent algorithm (Fig. 1) for the management of
NAFLD was proposed by Sattar et al. [1]. It strongly features measures of glycemia in assessing NAFLD
diagnosis and weight loss as a key therapeutic goal. Further work is needed to determine how NAFLD
presence relates to diabetes progression.
Figure 1. Proposed algorithm for diagnosis and initial management of suspected or
confirmed NAFLD in primary care. *Some biochemistry laboratories only measure one of
the transaminases and in such cases it will be necessary to request both ALT and AST tests
in relevant patients [1].
References
[1] Sattar N, Forrest E, Preiss D. Non-alcoholic fatty liver disease. BMJ 2014;349:g4596.
[2] Sattar N, Gill JM. Type 2 diabetes as a disease of ectopic fat? BMC Med 2014;12:123.
[3] Fraser A, Harris R, Sattar N, et al. Alanine aminotransferase, gamma-glutamyltransferase, and
incident diabetes: the British Women’s Heart and Health Study and meta-analysis. Diabetes Care
2009;32:741-750.
[4] Williamson RM, Price JF, Glancy S, et al. Prevalence of and risk factors for hepatic steatosis and
nonalcoholic Fatty liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes
Study. Diabetes Care 2011;34:1139-1144.
[5] Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of
beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia
2011;54:2506-2514.
[6] Yki-Jarvinen H. Type 2 diabetes: remission in just a week. Diabetologia 2011;54:2477-2479.
66 Postgraduate Course Syllabus • Metabolic Liver Disease
Given the above findings, it is clear that alteration in weight trajectory, and ideally some weight loss, is
a key facet of the management of NAFLD but how to best achieve this is often unclear. Nevertheless,
there is plentiful evidence that weight loss lessens risk of T2DM and improves liver fat levels in parallel
with improvements in hepatic insulin resistance. A recent algorithm (Fig. 1) for the management of
NAFLD was proposed by Sattar et al. [1]. It strongly features measures of glycemia in assessing NAFLD
diagnosis and weight loss as a key therapeutic goal. Further work is needed to determine how NAFLD
presence relates to diabetes progression.
Figure 1. Proposed algorithm for diagnosis and initial management of suspected or
confirmed NAFLD in primary care. *Some biochemistry laboratories only measure one of
the transaminases and in such cases it will be necessary to request both ALT and AST tests
in relevant patients [1].
References
[1] Sattar N, Forrest E, Preiss D. Non-alcoholic fatty liver disease. BMJ 2014;349:g4596.
[2] Sattar N, Gill JM. Type 2 diabetes as a disease of ectopic fat? BMC Med 2014;12:123.
[3] Fraser A, Harris R, Sattar N, et al. Alanine aminotransferase, gamma-glutamyltransferase, and
incident diabetes: the British Women’s Heart and Health Study and meta-analysis. Diabetes Care
2009;32:741-750.
[4] Williamson RM, Price JF, Glancy S, et al. Prevalence of and risk factors for hepatic steatosis and
nonalcoholic Fatty liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes
Study. Diabetes Care 2011;34:1139-1144.
[5] Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of
beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia
2011;54:2506-2514.
[6] Yki-Jarvinen H. Type 2 diabetes: remission in just a week. Diabetologia 2011;54:2477-2479.
66 Postgraduate Course Syllabus • Metabolic Liver Disease
