• non-alcoholic steatohepatitis

Non-alcoholic fatty liver disease (NAFLD) is often thought of as the hepatic manifestation of the metabolic syndrome and is frequently accompanied by type 2 diabetes, hypertension, dyslipidaemia and cardiovascular disease. Together with the obesity epidemic, NAFLD has reached epidemic proportions and is now the most common cause of chronic liver disease worldwide. Despite the epidemic of NAFLD, relatively few of these patients will die of liver disease and the leading cause of death among NAFLD patients is cardiovascular disease. Patients with NAFLD also experience significant morbidity from comorbid conditions, such as diabetes and chronic kidney disease. A liver-centric approach to the disease risks missing the forest for the trees.

In Frontline Gastroenterology, Moolla et al 1 illuminate one potential path through this forest by demonstrating the efficacy of a multidisciplinary approach to NAFLD in improving markers of liver, cardiac and metabolic health. This single centre, retrospective study examined a cohort of NAFLD patients referred to the Oxford University Hospital Metabolic Liver Clinic who were generally referred from the primary or secondary care setting with NAFLD and a NAFLD fibrosis score (NFS) in the intermediate to high range. Their multidisciplinary clinic was led by hepatologists and diabetologists or metabolic specialists and supported by a special service that provided patients with advice regarding weight loss, smoking cessation, alcohol reduction …