Evidence-Based Medicine
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World J Gastroenterol. Sep 14, 2014; 20(34): 12182-12201
Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12182
Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review
Juan P Arab, Roberto Candia, Rodrigo Zapata, Cristián Muñoz, Juan P Arancibia, Jaime Poniachik, Alejandro Soza, Francisco Fuster, Javier Brahm, Edgar Sanhueza, Jorge Contreras, M Carolina Cuellar, Marco Arrese, Arnoldo Riquelme
Juan P Arab, Roberto Candia, Alejandro Soza, M Carolina Cuellar, Marco Arrese, Arnoldo Riquelme, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
Rodrigo Zapata, Sección de Gastroenterología, Hospital del Salvador, Escuela de Medicina, Universidad de Chile, 7500922 Santiago, Chile
Rodrigo Zapata, Edgar Sanhueza, Jorge Contreras, Unidad de Gastroenterología, Universidad del Desarrollo, Clínica Alemana, 7650568 Santiago, Chile
Cristián Muñoz, Unidad de Trasplante Hepático, Hospital del Salvador, Unidad de Gastroenterología, Clínica Las Lilas, 7510524 Santiago, Chile
Juan P Arancibia, Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Chile, 8380456 Santiago, Chile
Jaime Poniachik, Javier Brahm, Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Escuela de Medicina, Universidad de Chile, 8380456 Santiago, Chile
Francisco Fuster, Digestive Diseases Unit, Clínica Reñaca, 2540364 Viña del Mar, Chile
Javier Brahm, Gastroenterology Department, Clínica Las Condes, 6770128 Santiago, Chile
Arnoldo Riquelme, Centre for Medical Education, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330024 Santiago, Chile
Author contributions: Arab JP, Candia R, Arrese M and Riquelme A designed the survey and coordinated the expert panel; Arab JP, Candia R, Zapata R, Muñoz C, Arancibia JP, Poniachik J, Soza A, Fuster F, Brahm J, Sanhueza E and Contreras J participated in the panel; Arab JP, Candia R, Cuellar MC, Arrese M and Riquelme A wrote the manuscript; all of the authors reviewed and approved the final draft.
Supported by (in part) Chilean Society of Gastroenterology; Grants from the Fondo Nacional De Ciencia y Tecnología de Chile, FONDECYT 1110455 to Arrese M and 1120652 to Riquelme A; and the Comisión Nacional de Investigación, Ciencia y Tecnología, CONICYT, basal project CARE Chile UC
Correspondence to: Arnoldo Riquelme, MD, MMedEd, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, 8330024 Santiago, Chile. a.riquelme.perez@gmail.com
Telephone: +56-2-23543820 Fax: +56-2-26397780
Received: December 29, 2013
Revised: March 27, 2014
Accepted: April 27, 2014
Published online: September 14, 2014
Processing time: 263 Days and 13.4 Hours
Abstract

AIM: To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice.

METHODS: NAFLD has now reached epidemic proportions worldwide. The optimal treatment for NAFLD has not been established due to a lack of evidence-based recommendations. An expert panel of members of the Chilean Gastroenterological Society and the Chilean Hepatology Association conducted a structured analysis of the current literature on NAFLD therapy. The quality of the evidence and the level of recommendations supporting each statement were assessed according to the recommendations of the United States Preventive Services Task Force. A modified three-round Delphi technique was used to reach a consensus among the experts.

RESULTS: A group of thirteen experts was established. The survey included 17 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 93.8% in the first round and 100% in the second and third rounds. The final recommendations support the indication of lifestyle changes, including diet and exercise, for all patients with NAFLD. Proven pharmacological therapies include only vitamin E and pioglitazone, which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis (the progressive form of NAFLD), although the long-term safety and efficacy of these therapies have not yet been established.

CONCLUSION: Current NAFLD management is rapidly evolving, and new pathophysiology-based therapies are expected to be introduced in the near future. All NAFLD patients should be evaluated using a three-focused approach that considers the risks of liver disease, diabetes and cardiovascular events.

Keywords: Nonalcoholic fatty liver disease; Steatosis; Consensus; Evidence-based medicine; Treatment

Core tip: Current nonalcoholic fatty liver disease (NAFLD) management is rapidly evolving, and new pathophysiology-based therapies are expected to be introduced in the near future. All NAFLD patients should be evaluated using a three-focused approach that considers risks of liver disease, diabetes and cardiovascular events. The final recommendations of this consensus support the indication of lifestyle changes, including diet and exercise, for all patients with NAFLD. Proven pharmacological therapies only consider vitamin E and pioglitazone, which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis (the progressive form of NAFLD), although the long-term safety and efficacy of these therapies have not been established.