Higado Graso y Estatosis

Digestive and Liver Disease 42 (2010) 272–282

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Digestive and Liver Disease
journal homepage: www.elsevier.com/locate/dld

Progress Report

Practice guidelines for the diagnosis and management of nonalcoholic fatty liver disease A decalogue from the Italian Association for the Study of the Liver (AISF) Expert Committee
P. Loria a,∗ , L.E.Adinolfi b , S. Bellentani c , E. Bugianesi d , A. Grieco e , S. Fargion f , A. Gasbarrini g , C. Loguercio h , A. Lonardo a , G. Marchesini i , F. Marra j , M. Persico k , D. Prati l,m , G. Svegliati- Baroni n , The NAFLD Expert Committee of the Associazione Italiana per lo studio del Fegato (AISF)
a

Dipartimento di Medicina Interna, Endocrinologia, Metabolismo e Geriatria, Università di Modena eReggio Emilia, Nuovo Ospedale Sant’Agostino Estense di Baggiovara, Via del Pozzo 71, 41100 Modena, MO, Italy Dipartimento di Medicina Interna ed Epatologia, Seconda Università di Napoli, Naples, Italy c Centro studi Fegato, Gastroenterologia, Ospedale “Ramazzini” di Carpi, Modena, Italy d Divisione di Gastro-Epatologia, Ospedale San Giovanni Battista, Università di Torino, Turin, Italy e Istituto diMedicina Interna, Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy f Dipartimento di Medicina Interna, Fondazione Policlinico, Mangiagalli e Regina Elena, IRCCS, Università di Milano, Milan, Italy g Dipartimento di Medicina Interna, Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy h Centro Interuniversitario perRicerche su Alimenti, Nutrizione e Apparato Digerente, Naples, Italy i Dietetica Clinica, Alma Mater Studiorum Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy j Dipartimento di Medicina Interna, Azienda Ospedaliera Universitaria Careggi, Università di Firenze, Florence, Italy k Unità di Medicina Interna ed Epatologia, Seconda Università di Napoli, Naples, Italy l Dipartimento diMedicina Trasfusionale e di Ematologia dell’Ospedale “Alessandro Manzoni, Lecco, Italy m Centro di Medicina Trasfusionale, Terapia Cellulare e Criobiologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy n Dipartimento di Gastroenterologia, Università della Marche – Politecnico, Ancona, Italy
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We report the evidence-basedItalian Association for the Study of Liver guidelines for the appropriate diagnosis and management of patients with nonalcoholic fatty liver disease in clinical practice and its related research agenda. The prevalence of nonalcoholic fatty liver disease varies according to age, gender and ethnicity. In the general population, the prevalence of nonalcoholic fatty liver disease is about 25% and theincidence is of two new cases/100 people/year. 2–3% of individuals in the general population will suffer from nonalcoholic steatohepatitis. Uncomplicated steatosis will usually follow a benign course. Individuals with nonalcoholic steatohepatitis, however, have a reduced life expectancy, mainly owing to vascular diseases and liver-related causes. Moreover, steatosis has deleterious effects on thenatural history of HCV infection. Nonalcoholic fatty liver disease is usually diagnosed in asymptomatic patients prompted by the occasional discovery of increased liver enzymes and/or of ultrasonographic steatosis. Medical history, complete physical examination, etiologic screening of liver injury, liver biochemistry tests, serum lipids and insulin sensitivity tests should be performed in everypatient. Occult alcohol abuse should be ruled out. Ultrasonography is the first-line imaging technique. Liver biopsy, the gold standard in diagnosis and prognosis of nonalcoholic fatty liver disease, is an invasive procedure and its results will not influence treatment in most cases but will provide prognostic information. Assessment of fibrosis by composite scores, specific laboratory parameters and...