Collaborating for Better Outcomes in Patients with Fatty Liver Disease

Nonalcoholic fatty liver disease is a growing worldwide health problem and has been linked to common disorders such as Type 2 diabetes and cardiovascular disease. To improve outcomes for patients with fatty liver disease, Kenneth Cusi, M.D., FACP, FACE, chief of the University of Florida College of Medicine’s Division of Endocrinology, Diabetes and Metabolism, says, “We need a multidisciplinary approach with endocrinologists and hepatologists working together to get the upper hand in managing fatty liver disease.”

Cusi recently co-authored an article in the journal Lancet Diabetes & Endocrinology in which novel concepts related to the diagnosis, risk prediction and treatment of fatty liver disease are highlighted. The authors note that reliable noninvasive tools for diagnosing non-alcoholic fatty liver disease, or NAFLD, are needed, especially in patients with insulin resistance or diabetes, and that diagnosis is needed earlier because such comorbidities can strongly affect patients with advanced stages of the disease.

Still, Cusi and his colleagues point out that fatty liver disease can be identified when the patient is evaluated and can then be treated, calling for endocrinologists and hepatologists to work together to manage its deleterious hepatic and extrahepatic effects. Cusi explains, “Increased liver fat content is a stronger determinant of insulin resistance and cardiovascular disease than total body fat mass or even visceral fat mass.” Cusi notes that in NAFLD, the liver becomes an indicator of cardiometabolic health—a barometer that allows the identification of individuals, both with and without obesity, who are insulin-resistant and in a metabolic state of severe adipose-tissue dysfunction and lipotoxicity. Patients with Type 2 diabetes and NAFLD have the highest cardiometabolic disease risk.

In reviewing current treatments for fatty liver disease, the authors note most doctors are unaware that weight loss by lifestyle modification and bariatric surgery improve inflammation and liver fibrosis. In addition, certain pharmacological agents used to treat diabetes, particularly pioglitazone, offer significant benefit to patients reversing liver steatosis, inflammation and, on occasion, fibrosis.

At UF Health, endocrinologists and hepatologists are putting theory into practice by applying these emerging concepts in a collaborative environment focused on advancing management and improving outcomes for patients with fatty liver disease.