Cusi Kenneth, Budd Jeff, Johnson Eric, Shubrook Jay
Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL.
Division of General Internal Medicine, University of Florida, Gainesville, FL.
Diabetes Spectr. 2024 Winter;37(1):29-38. doi: 10.2337/dsi23-0014. Epub 2024 Feb 15.
Standards of care summarized in clinical practice guidelines for nonalcoholic fatty liver disease (NAFLD) offer clinicians a streamlined diagnostic and management approach based on the best available evidence. These recommendations have changed a great deal in recent years; today, there is a clear focus on screening for the early identification and risk stratification of patients at high risk of steatohepatitis and clinically significant fibrosis to promote timely referrals to specialty care when needed. This article reviews and provides the rationale for current guidelines for NAFLD screening, diagnosis, treatment, and monitoring and addresses barriers to providing evidence-based NAFLD care and how to overcome them. The current paradigm of care calls for primary care clinicians and specialists to work together, within a multidisciplinary care team familiar with obesity and diabetes care, to provide comprehensive management of these complex patients.
非酒精性脂肪性肝病(NAFLD)临床实践指南中总结的护理标准为临床医生提供了一种基于现有最佳证据的简化诊断和管理方法。近年来,这些建议发生了很大变化;如今,明确重点在于筛查,以早期识别非酒精性脂肪性肝炎和具有临床意义的肝纤维化高危患者并进行风险分层,以便在需要时及时转诊至专科护理。本文回顾并阐述了当前NAFLD筛查、诊断、治疗和监测指南的基本原理,并探讨了提供循证NAFLD护理的障碍以及如何克服这些障碍。当前的护理模式要求初级保健临床医生和专科医生在熟悉肥胖症和糖尿病护理的多学科护理团队中共同合作,为这些复杂患者提供全面管理。