Northwell Health, Lenox Hill Hospital New York, NY, United States
Megan C. Buckley, DO1, Sohil Khurana, DO2, Vinayak Shenoy, DO3, Ethan Fried, MD4 1Northwell Health, Lenox Hill Hospital, New York, NY; 2Lenox Hill Hospital, Northwell Health, New York, NY; 3Northwell Health Lenox Hill Hospital, New York, NY; 4Lenox Hill Hospital, New York, NY
Introduction: Nonalcoholic fatty liver disease (NAFLD) is the greatest cause of liver disease in Western society. NALFD is diagnosed by detection of hepatic steatosis on imaging in the absence of other causes of liver damage. Although there are efforts to treat NAFLD with medications, the mainstay of treatment therapy is lifestyle modifications, highlighting the importance of proper nutritional counseling. At initial diagnosis, it is essential to evaluate patients for metabolic syndromes, like diabetes and hyperlipidemia. Our goal was to characterize the severity of incidentally found hepatic steatosis and assess the rate at which patients were formally counseled by a dietitian inpatient.
Methods: We performed a retrospective chart review of adult patients admitted to the internal medicine service at our academic community hospital, who underwent an abdominal sonogram between January 2016 and February 2017. Patients included in this study were documented to have steatosis, fatty infiltration, or fatty liver on imaging. Patients with excessive alcohol use, chronic hepatitis, hemochromatosis, cirrhosis, hepatocellular carcinoma, Wilson’s disease, or who were pregnant were excluded from this study. Variables such as patient demographics, indication for abdominal US, AST/ALT, lipid panel, hemoglobin A1c, calculated NAFLD fibrosis scores, if a dietitian was consulted, and if a dietitian evaluated the patient were all collected.
Results: Of the 821 patients with abdominal ultrasounds, 71 (8.6%) met inclusion criteria. From these 71 patients, 21 (29.6%) had a NAFLD fibrosis score of F3-F4 indicating severe fibrosis to cirrhosis. The majority of patients (45, 63.4%) had abnormal liver enzymes. Hemoglobin A1c was checked for 39 patients (54.9%), lipid panel for 18 patients (25.4%), and for 26 patients (36.6%), neither was checked. An official dietitian consult was ordered for 32 patients total (45%), but only 26 patients (36.6%) were actually evaluated by a dietitian.
Discussion: This study illustrates that when incidentally diagnosed, NAFLD is often insufficiently worked-up and treated, despite nearly one-third of patients having severe fibrosis or cirrhosis. High-risk patients in particular need a thorough work-up to identify underlying metabolic disorders and early intervention with diet and exercise. We plan to implement an alert in the electronic medical record (EMR) system that automatically triggers a dietitian consult for patients who are incidentally found to have NAFLD on inpatient imaging.
Megan Buckley indicated no relevant financial relationships.
Sohil Khurana indicated no relevant financial relationships.
Vinayak Shenoy indicated no relevant financial relationships.
Ethan Fried indicated no relevant financial relationships.
Megan C. Buckley, DO1, Sohil Khurana, DO2, Vinayak Shenoy, DO3, Ethan Fried, MD4. P1784 - Improving Initial Diagnosis and Treatment of NAFLD With Inpatient Nutrition Counseling, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.