Obesity in adults: a clinical practice guideline

Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health.
People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index.
This guideline update reflects substantial advances in the epidemiology, determinants, pathophysiology, assessment, prevention and treatment of obesity, and shifts the focus of obesity management toward improving patient-centred health outcomes, rather than weight loss alone.
Obesity care should be based on evidence-based principles of chronic disease management, must validate patients’ lived experiences, move beyond simplistic approaches of “eat less, move more,” and address the root drivers of obesity.
People living with obesity should have access to evidence-informed interventions, including medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and surgery.

Author/s:

Wharton, Sean, Lau, David C., Vallis, Mchael, Sharma, Arya M., Biertho, Laurent, Campbell-Scherer, Denise, Adamo, Kristi, Alberga, Anela, Bell, Rhonda, Boule, Normand, Boyling, Elaine, Calam, Betty, Brown, Jennifer, Clarke, Carol, Crowshoe, Lindsay", Mary, Freedhoff, Yoni, Gagner, Michel, Grand, Cindy, Glazer, Stephen", Michael, Hahn, Margaret, Hawa, Raed, Henderson, Rita, Hong, Dennis, Hung, Pam, Janssen, Ian, Jacklin, Kristen, Johnson-Stoklossa, Carlene, Kemp, Amy, Kirk, Sra, :Kuk, Jennifer, Langlois, Marie-France, Lear, Scott, McInnes, Ashley, Macklin, David, Naji, Leen, Manjoo, Priya, Morin, Marie-Philippe, Nerenberg, Kara, Patton, Ian, Pedersen, Sue, Pereira, Leticia, Piccinini-Vallis, Helena, Poddar, Megha, Poirier, Paul, Prud'homme, Denis, Romos Salas, Ximena, Rueda-Clausen, Christian, Russell-Mayhew, Shelly, Shiau, Judy, Sherifali, Diana, Sievenpiper, John, Sockalingam, Sanjeev, Taylor, Valerie, Toth, Ellen, Twells, Laurie, Tytus, RIchard, Walji, Shahebina, Walker, Leah

Diagnosis and Management of Nonalcoholic Liver Disease

Jeffrey Wilson — Tue, 27 Nov 2018 22:38:28 +0000

Date Added:

November 27, 2018

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

November 26, 2018

URL:

Diagnosis and Management of Nonalcoholic Liver Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2018.17365

Keywords

non-alcoholic liver disease

non-alcoholic fatty liver disease

liver disease

liver cirrhosis

MeSH

non-alcoholic fatty liver disease

Hydroxymethylglutaryl-CoA Reductase Inhibitors

diagnostic tests, routine

liver cirrhosis

This is a summary of the most recent (2017) Guideline recommendations for evaluation and management of non-alcoholic live disease from the American Association for the Study of Liver Diseases (AASLD).

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MAJOR RECOMMENDATIONS

• Patients with incidental hepatic steatosis detected on imaging who lack any liver-related symptoms or signs and have normal liver biochemistries should be assessed for metabolic risk factors (eg, obesity, diabetes mellitus, dyslipidemia) and other causes of hepatic steatosis, including alcohol consumption (>14 drinks per week for women; >21 drinks per week for men) and medications.

• Routine screening for NAFLD in high-risk groups is not advised because of uncertainties surrounding diagnostic tests and treatment options, along with lack of knowledge about long-term benefits and cost-effectiveness of screening.

• The FIB-4 (age, aspartate aminotransferase, alanine aminotransferase, platelets) and NAFLD Fibrosis Score (NFS, which adds body mass index and albumin) are clinically useful tools to predict bridging fibrosis.

• Vibration-controlled transient elastography (VCTE) or magnetic resonance elastography (MRE) can noninvasively assess for advanced fibrosis.

• Weight loss generally reduces hepatic steatosis, either by hypocaloric diet alone or in conjunction with increased physical activity.

• Pharmacologic treatments should be limited to patients with biopsy-proven nonalcoholic steatohepatitis (NASH) and advanced fibrosis.

• Statins can be used to treat dyslipidemia in patients with NAFLD, NASH, and compensated NASH cirrhosis.

Author/s:

Paul, Sonali, Davis, Andrew M.