In adults with NAFL, when should pharmacologic therapy start after lifestyle failure? скачать в хорошем качестве

In adults with NAFL, when should pharmacologic therapy start after lifestyle failure?

Adults with nonalcoholic fatty liver disease (NAFL) who have persistent abnormal liver enzymes after six months of lifestyle intervention present a common clinical dilemma: whether to continue observation or initiate pharmacologic therapy. Persistent enzyme elevations alone do not reliably indicate disease progression, making the decision challenging. This discussion outlines a decision framework where lifestyle management remains the default, with pharmacologic therapy considered only if there is evidence of advanced fibrosis, cirrhosis, metabolic comorbidities such as type 2 diabetes, or strong patient preference. Emphasis is placed on avoiding treatment based solely on enzyme levels or surrogate markers and on tailoring decisions to individual clinical risk factors. This approach reinforces lifestyle modification as the cornerstone while highlighting clear triggers for escalation. #hepatology #NAFLD #liverdisease #internalmedicine #metabolicdisease