Liver biopsy is the gold standard for the diagnosis and prognosis of NAFLD in its all continuum; but it is invasive, expensive, has sampling errors and other problems that have been reported.
A large number of studies have been conducted in these patients to find serologic biomarkers to differentiate simple steatosis from steato-hepatitis and diagnose advanced fibrosis as well.
Do you use any of them in your routine routine practice?
Are you using diagnostic panels like NFS score or FibroMeter or other markers in your routine practice?
Nonalcoholic steatohepatitis is a common chronic liver disease throughout the world. Experimental and clinical research continues to achieve validation and qualification of biomarkers in NASH, which will hopefully assist the development of new treatments for NASH patients. Really I follow the cases with routine tests such as ALT, PT, TG, Cholesterol, LDL-C, HDL-C, Uric Acid, CRP and ferritin Level in my daily practice. I should emphasize on the ferritin level.
Thanks, what about other markers like GGT, platelet count, and albumin?
Do you use or recommend using panels like NFS score?
Checking serum ferritin level is important since iron deposition is accompanied with more liver injury in NAFLD.
How about Diabetes? How often should we check them for DM? Should we follow the current protocol for DM screening in these patients? or there is special recommendations.
I think for evaluation of diabetes we need to: FBS, GGT and HgA1c
Dear Dr Eshraghian:
Correlation of diabetes and Fatty liver disease can be viewed from two viewpoints. We all know that diabetes is a major risk factor for NAFLD and even severe forms of NAFLD. The other viewpoint is the reverse correlation. Can NAFLD be a risk for the development of diabetes?
As NAFLD has been recognized as the hepatic manifestation of metabolic syndrome, which itself includes DM, one can hypothesize that the risk of developing DM in a patient with NAFLD should be higher than general population. But to my knowledge there is no evidence for screening for DM more than usual. Even in DM cases search for NAFLD has not been recommended in the latest guidelines!
Patients with NAFLD are at increased risk for development of diabetes.. Therefore more frequent assessment for diabetes and more aggressive management of these patients may be warranted
Sure, as I mentioned before this is what I think too. I probably do the same thing that you admit; but having a routine and having evidence based practice differ!
Is there any evidence for this practice? If yes I would be happy to see it.
Dear Dr Alavian:
It is a great pleasure that you are using GGT in the evaluation of NAFLD patients!
I agree in DM cases search for NAFLD is not recommended in in general practice, but screening for diabetes in all NAFLD is necessary.