Navigating Non-Alcoholic Fatty Liver Disease (NAFLD) in Patients with Type 2 Diabetes: A Comprehensive Approach

Respond to what the person wrote to this discussion in one paragraph 2 references APA 7TH edition

Janice is a 45yo Caucasian female with symptoms of Non-Alcoholic Fatty Liver Disease. Her BMI is 40 and she was diagnosed with DM2 3 years ago. Her last HgbA1c was 7.4. She lives a sedentary lifestyle. She states she has significant fatigue but is otherwise asymptomatic.

What diagnostics would you order for Janice? Why?

Most patients with NAFLD are asymptomatic and difficult to diagnose. Their symptoms may be vague such as abdominal discomfort, fatigue and nausea, and therefore need further testing to get an accurate diagnosis which include imaging test such as an abdominal ultrasound, a magnetic resonance (MRI) or a CT scan. An ultrasound cannot identify inflammation or fibrosis but is the first imaging study done to evaluate for hepatic steatosis. A CT scan can be done to assess the structure of the liver. It is an option for determining hepatic steatosis; however, there is significant radiation associated with this imaging study. Through blood test, the liver enzymes Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) are used to determine if there are liver problems. Transient elastography is a newer imaging study on the horizon. Described as a pulse-echo ultrasound, it has shown usefulness in determining the presence of fibrosis. This may be helpful in determining if a liver biopsy is necessary. A liver biopsy is the gold standard for determining if NAFLD is present and for staging the severity of NAFLD.

What treatment plan would you recommend for her?

The first treatment plan I would recommend for Janice is a lifestyle change of getting up and moving. Initially, increased physical activity, a low cholesterol/low-fat diet, decreased caloric consumption, avoidance of trans fats, and weight loss can make significant improvements in the disease. Lifestyle modifications not only have the potential to improve liver disease but can also improve common comorbidities (for example, hypertension, diabetes, and hyperlipidemia) The Mediterranean diet has shown improvement in hepatic steatosis and insulin sensitivity in NAFLD patients. Encouraging a reduction in calories along with good food choices is recommended. Dietary changes should include complete avoidance of high-fructose corn syrup and trans fats, as these dietary choices are associated with hepatic steatosis development and insulin resistance. Patients with NAFLD should not consume alcohol. Interestingly, some studies have been performed supporting that coffee consumption is associated with reducing hepatic fibrosis. One or two cups of unsweetened coffee can be seen as a benefit in patients with NAFLD. A weight loss of 3% to 10% can improve disease progression and normalization of AST levels, but weight gain can lead to NASH recurrence. Hepatic steatosis can be reduced with even a 3% weight loss. Exercise, both with and without weight loss, has shown benefits for the patient with NAFLD.

What is her prognosis?

Janice has a chance of living a long life if she sticks to a diet change, exercises, and monitors her blood sugars and A1C. If there is little damage to her liver, she can reverse the symptoms of the disease before it progresses.

References

Chaney A. (2015). Treating the patient with nonalcoholic fatty liver disease. The Nurse Practitioner, 40(11), 36–43.

https://doi.org/10.1097/01.NPR.0000472248.28703.18

ANSWER

In response to the comprehensive plan outlined for Janice’s Non-Alcoholic Fatty Liver Disease (NAFLD), it’s commendable to see the consideration of various diagnostic modalities and the emphasis on lifestyle modifications in the treatment plan. The suggestion to utilize imaging tests such as abdominal ultrasound, CT scans, and possibly transient elastography to assess liver health and fibrosis status aligns with current diagnostic guidelines for NAFLD. Moreover, the emphasis on lifestyle changes, including increased physical activity, dietary modifications such as the Mediterranean diet, and avoidance of alcohol and trans fats, is crucial in managing NAFLD, particularly in individuals with comorbidities like type 2 diabetes. Additionally, the incorporation of exercise, even without significant weight loss, is noteworthy for its potential benefits in improving liver health and metabolic parameters. The prognosis outlined for Janice is optimistic, highlighting the potential for disease regression and improved outcomes with adherence to lifestyle modifications and close monitoring of liver function and glycemic control. This holistic approach addresses the multifactorial nature of NAFLD and underscores the importance of personalized care to optimize Janice’s long-term health outcomes.

References:

Chaney, A. (2015). Treating the patient with nonalcoholic fatty liver disease. The Nurse Practitioner, 40(11), 36–43. https://doi.org/10.1097/01.NPR.0000472248.28703.18

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