The prevalence of nonalcoholic liver disease (NAFLD) is increasing worldwide in conjunction with the epidemic increase in obesity and metabolic risk factors. Consequently, NAFLD has become a leading indication for liver transplantation. Although genetic factors play an important role in the pathogenesis of NAFLD, detrimental lifestyle trends favoring a calorically unrestricted diet rich in carbohydrates and unsaturated fat, prolonged sedentary periods or limited physical activity have major metabolic implications. In aggregate these physiological dysregulations constitute the main risk factors for the metabolic syndrome and NAFLD. The cornerstone of the treatment of NAFLD, is lifestyle changes, including modifications to diet and physical activity, to reduce body weight and liver fat, however adherence is notoriously poor and the epidemic of NAFLD continues to grow unimpeded. In the face of this unmet clinical need, the pharmacologic therapy of NAFLD has been expanding as the varied mechanistic pathways of NAFLD are elucidated. Beyond these approaches to treating NAFLD, the prevention of other liver diseases is additionally important. Chief among these is alcoholic liver disease, and heavy use is detrimental irrespective of underlying NAFLD. However, the impact of mild to moderate alcohol use in patients with mild or nonadvanced forms NAFLD is undefined. This article summarizes the results of the International Liver Transplantation Society consensus meeting on NAFLD in liver transplantation. It describes the available evidence and provides consensus guidance on the lifestyle and pharmacologic therapies of NAFLD, and the consensus position on alcohol use in patients with NAFLD.
1 Sorbonne Université, Institute for Cardiometabolism and Nutrition, Hospital Pitié Salpêtrière, Paris, France.
2 Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN.
3 University Hospital, Virgen del Rocio, Institute of Biomedicine of Seville, University of Seville, Sevilla, Spain.
4 Department of Gastroenterology and Obesity Center, Polytechnic University for Marche, Ancona, Italy.
Received 17 July 2018. Revision received 14 September 2018.
Accepted 25 September 2018.
V.R. is in the consultancy or advisory board meetings for Allergan, Boehringer, Galmed, Genfit, Intercept, Novartis, Novo-Nordisk. M.G. did a research support Salix Pharmaceutical. M.R.-G. is in the consultancy or advisory board meetings for Allergan, Intercept, Medimmune, Gilead, Novo-Nordisk. G.S.-B. is in the Advisory board meetings for Gilead.
All authors took part in the meeting, the discussions and provided input on the grading of recommendations. M.G. wrote the text on physical exercise. M.R.-G. wrote the text on dietary interventions, G.S.-B. wrote the text on alcohol consumption. V.R. wrote the text on pharmacological therapy. V.R. was responsible for editing of the whole article and all authors approved the final version.
Correspondence: Vlad Ratziu, MD, PhD, Sorbonne Université, Institute for Cardiometabolism and Nutrition, Hospital Pitié Salpêtrière, Paris, France. (firstname.lastname@example.org).