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La stéatopathie dysmétabolique ou NASH : faut-il dépister les patients à haut risque atteints de diabète de type 2 ou d’obésité ?

Abstract : Nonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide. It encompasses a spectrum of phenotypes including benign hepatic steatosis (NAFL) and nonalcoholic steatohepatitis (NASH) which is considered as the progressive form with higher risk of progression towards liver fibrosis, cirrhosis or hepatocellular carcinoma. NAFLD remains asymptomatic until end-stage of the disease and is largely underdiagnosed. In the last decades, populations at high risk of progression to advanced fibrosis, such as obese and type 2 diabetic (T2D) patients, have been identified. The presence of advanced fibrosis has been identified as the major determinant of overall and hepatic mortality. Liver biopsy remains the gold standard for the diagnosis of NASH and hepatic fibrosis, however several noninvasive blood-based and imaging-based biomarkers have been developed for the assessment and screening for liver fibrosis. Finally, the lifestyle modification and weight loss intervention improve steatosis, NASH and liver fibrosis, and therapeutic clinical trials for the treatment of NASH are an area of intensive research. This review article will summarize the current evidence supporting the systematic screening for advanced fibrosis in high-risk population such as T2D and obese patients. Several modalities are available for such screening. However, additional studies are needed to determine the optimal strategy for a systematic screening in high risk population and to allow efficient and cost-effectiveness pathway referral in hepatology clinics. (C) 2020 Societe francophone nutrition clinique et metabolisme (SFNCM).
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Submitted on : Friday, June 11, 2021 - 10:04:47 AM
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Cyrielle Caussy. La stéatopathie dysmétabolique ou NASH : faut-il dépister les patients à haut risque atteints de diabète de type 2 ou d’obésité ?. Nutrition Clinique et Métabolisme, Elsevier Masson, 2020, 34 (2), pp.122-129. ⟨10.1016/j.nupar.2019.12.005⟩. ⟨hal-03257703⟩

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