Question
How should a patient with NAFLD and RUQ pain (but no diabetes) be managed, and how often should the patient be followed? What about the safety of weight loss in such a patient?
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Response from Rowen K. Zetterman, MD Professor and Dean, Creighton University School of Medicine; Physician, Creighton University Medical Center, Omaha, Nebraska |
I make the assumption that your patient is overweight as the potential cause for the diagnosis of nonalcoholic fatty liver disease (NAFLD), because you asked about the safety of weight loss. Right upper quadrant abdominal pain does occur in some patients with fatty liver. The character of the pain may range from a dull ache to a burning type of pain and is often continuous.
After an initial evaluation to establish the likelihood of NAFLD as the cause of abdominal discomfort, the treatment should focus on the underlying associated conditions, in this case the patient's excess weight, and then proceeding with necessary lifestyle modifications, such as a low-fat, low-carbohydrate diet, weight reduction, and exercise. For most patients, I ask them to engage in a 10% body weight reduction, coupled with gradually increased exercise up to 30-45 minutes daily.
In my experience, for patients with pain, weight reduction often improves the associated discomfort. How vigorous this exercise should be has been debated, and its effects on NAFLD needs further study. However, I am unaware of any literature suggesting any hepatic risk to patients with NAFLD who achieve modest body weight loss.
The frequency of follow-up care should be dictated by the patient's associated conditions and need for observation, such as improvement of type 2 diabetes mellitus or hyperlipidemia. For patients being followed for weight loss effectiveness, seeing them every 1-2 months at the outset to provide reassurance and guidance can be helpful.