Checklist for Non-Alcoholic Fatty Liver Disease

[checklist name="variable_1" value="Weight loss is the primary therapy for most patients with NAFLD and if a patient's BMI is over 25, weight loss can lead to improvement in biochemical tests, liver histology, serum insulin levels and also quality of life. A weight loss of 5-15 percent is often most beneficial. The weight loss should be gradual, aiming for 0.5 to 1.0kg per week. Consultation with a dietician should be recommended.|A diet low in complex carbohydrates (pasta, bread, rice, potatoes, etc) and also low in simple sugars (high fructose corn syrup, soda, candy, etc) is recommended in patients with NAFLD. Lean protein, vegetables, and limited fresh fruits are acceptable.|Abstain from alcohol, but specifically heavy alcohol usage (greater than 14 drinks per week for men and greater than 7 drinks per week for women) as heavy alcohol usage is associated with disease progression.|Patients should be immunized against Hepatitis A and B.|Modify risk factors for cardiovascular disease. Patients with NAFLD are at increase risk for cardiovascular disease and often have multiple risk factors including hyperlipidemia and hypertension. Close attention should be placed on monitoring cholesterol and blood pressure and medications should be initiated when indicated. Statins do not need to be discontinued in the setting of elevated liver enzymes, unless the elevation is greater than three times the normal limit.|If the patient has diabetes in conjunction with NAFLD, optimization of blood glucose control is recommended. If the patient has not been diagnosed with diabetes, it is recommended that fasting insulin and glucose be monitored closely and even monitor the HOMA score.|Vitamin E could be considered in patients with biopsy proven NASH, at doses of 800IU daily, but should not be used in patients with diabetes mellitus, males with family or personal history of prostate cancer, or decompensated cirrhosis."]