Dr. Rotman and his colleagues are also currently conducting a small study seeking the optimal dose of the antioxidant vitamin E in patients with NASH.
Gene studies, so far, account for only a fraction of fat in the liver, he noted. "They are polygenic disorders affected by many genes, with each gene making a small contribution," he said in an interview. "The bottom line is that as we learn more, we’ll find more of these genetic contributions – these are genes we don’t know anything about, and they’ll teach us much about normal physiology as well."
For clinicians treating patients with NAFLD, the question of whether and when to biopsy can be difficult, Dr. Rotman continued, not least because management strategy is largely the same whether or not there is histological evidence of NASH.
"In the research setting, biopsy is recommended because it’s the only way you can learn about the disease," he said. "In the clinical setting, the predominant reason I’ll send a patient to an invasive procedure is if it’s going to change management. Since there is no approved treatment for NAFLD and almost every patient with NAFLD will have to change their lifestyle – lose weight, exercise, and eat a healthy diet – it is not necessary to biopsy routinely."
However, he said, a biopsy "assures that you are not missing a completely different disorder, and there may be some benefit to be able to stage and give a prognosis. With some patients, a scary biopsy result can help them focus on changing their lifestyle."
Dr. Rotman disclosed no conflicts of interest.