From the Guidelines
Patients with hepatic steatosis should undergo regular monitoring with a stepwise approach using blood-based scores, such as the fibrosis-4 index (FIB-4), and sequentially, imaging techniques, like transient elastography, to rule-out/in advanced fibrosis, as recommended by the latest guidelines 1.
Monitoring and Diagnosis
The monitoring strategy should include:
- Initial evaluation with a comprehensive metabolic panel, complete blood count, and lipid profile
- Liver function tests every 6-12 months, including ALT, AST, and GGT
- Imaging follow-up with ultrasound annually to assess disease progression
- Consideration of Fibroscan or MRI elastography every 1-2 years for patients with advanced disease to evaluate fibrosis progression
Treatment and Management
The primary treatment goal is weight loss of 7-10% through:
- Dietary changes, such as reduced processed foods, sugars, and saturated fats
- Regular exercise, aiming for 150 minutes weekly of moderate activity
- Optimal management of comorbidities, including the use of incretin-based therapies (e.g., semaglutide, tirzepatide) for type 2 diabetes or obesity, if indicated
- Consideration of bariatric surgery for individuals with MASLD and obesity
- Potential use of resmetirom for non-cirrhotic MASH with significant liver fibrosis (stage ≥2), if locally approved and dependent on the label 1
Key Considerations
- Regular screening for complications like cardiovascular disease and hepatocellular carcinoma is essential, as fatty liver disease increases these risks
- Monitoring is crucial because hepatic steatosis can progress silently to more severe forms, including steatohepatitis, fibrosis, and cirrhosis, if left unmanaged
- A stepwise approach to monitoring and management, as outlined in the latest guidelines, can help improve outcomes for patients with hepatic steatosis 1
From the Research
Hepatic Steatosis Monitoring Guidelines
Hepatic steatosis, also known as fatty liver disease, is a condition where excess fat builds up in the liver. Monitoring and diagnosis of this condition are crucial for effective management and treatment. The following are some guidelines and methods for monitoring hepatic steatosis:
- Imaging Techniques: Various imaging techniques can be used to monitor hepatic steatosis, including:
- Ultrasonography: a well-established and cost-effective method for detecting moderate-to-severe hepatic steatosis 2
- Magnetic Resonance Imaging (MRI): considered one of the most accurate methods for measuring liver fat in clinical practice 2, 3
- Computed Tomography (CT): not recommended for general population assessment due to inaccuracy in detecting mild hepatic steatosis and potential radiation hazard 2
- Non-Invasive Methods: Non-invasive methods, such as:
- Controlled Attenuation Parameter (CAP): a potential diagnostic and monitoring tool for hepatic steatosis 4
- Magnetic Resonance Spectroscopy (MRS): accurately estimates the severity of steatosis, provided the stage of fibrosis is considered 3
- Quantitative Ultrasound: emerging techniques that possess many inherent advantages, including universal availability, real-time capability, and relatively low cost 5
- Liver Biopsy: Although liver biopsy is still the gold standard for diagnosis, it has various shortcomings, such as invasive nature, risk of complications, and possibility of sampling error 4, 2, 3
- Elastography Techniques: Elastography-based techniques, such as ultrasound elastography and magnetic resonance elastography, are increasingly used to evaluate the degree of liver fibrosis in patients with NAFLD and to differentiate NASH from simple steatosis 2, 6