Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-Alcoholic Fatty Liver Disease (NAFLD) Screening and Management Initiative

Introduction

Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common Chronic Liver DiseaseCondition globally, estimated to affect up to one-third of adults worldwide. In India, the estimated prevalence ranges from 9- 53%. NAFLD is closely and primarily associated with Obesity,Type 2 Diabetes Mellitus, Dyslipidemia, Hypertension andCoronary Artery Disease. Due to its widespread prevalence and the increased risk of developing liver cirrhosis and cancer, NAFLD has been identified as a disease requiring a robust primary care component through prevention and control.

Co-MorbiditiesassociatedwithNAFLD/MASLD

NAFLD is strongly associated with rising rates of Obesity and Metabolic Dysfunction. The prevalence is increasing due to changing dietary patterns and sedentary lifestyles. Cardiovascular disease is the most common cause of mortality in NAFLD, suggesting a close interlink with other Non-Communicable Diseases (NCDs).

SpectrumofDiseaseprogression

• NASH–Non–AlcoholicSteatoHepatitis

StructuredImplementationStrategyforNAFLD/MASLDinTamilNadu

• NAFLD is designed and included within the broad structure of NP-NCD at each level of health care delivery.
• The key strategies include prevention and identification of the condition at various levels of healthcare.
• Thefirst step begins at the community level where the WHVs will refer the alreadyline listed HT/ DM patients in the community to PHC to undergo assessment for Liver Function.
• At PHC/ GH/MCH, the line listed HT/DM patients referred by WHVs or already in the institutional care will be assessed Fib-4 score which is based on Age, BMI, SGOT/SGPT andPlatelets.Sincethereis IELS, thepatients treated for HT/DM would haveaccess to LFT and Lipid Profile test whereas Urine Albumin, Serum Creatine, e-GFR, CBC and baseline ECG would be available as such in all the health facilities. This standard protocol or assessment would become an integral part of MTM Program.
• Based on the above Tests, if individuals are Fib – 4 score positive, they would be referred to secondary care where the diagnosis of NAFLD and risk stratification for advanced liver fibrosis will be done by experts.
• Thosepatientswhoare negativeinFib -4scorewillbe counselled forweight reduction, Lifestyle modifications, Diet counselling and will be subjected to annual repeat assessment.
• For all the newly screened and identified HT/DM patients, the above steps would automatically apply.