The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases

Abstract

PreambleThis guidance provides a data-supported approach to the diagnostic, therapeutic, and preventive aspects of nonalcoholic fatty liver disease (NAFLD) care. A "Guidance" document is different from a "Guideline." Guidelines are developed by a multidisciplinary panel of experts and rate the quality (level) of the evidence and the strength of each recommendation using the Grading Abbreviations: AASLD, American Association for the Study of Liver Diseases; ACG, American College of Gastroenterology; AIH, autoimmune hepatitis; ALT, alanine aminotransferase; APRI, AST to platelet ratio index; AST, aspartate aminotransferase; AUROC, area under the receiver operating

Metastasis‐associated lung adenocarcinoma transcript 1 as a common molecular driver in the pathogenesis of nonalcoholic steatohepatitis and chronic immune‐mediated liver damage

“…Irrespective of whether NAFL and NASH should be considered as having different long‐term clinical impact, it is clear that the progression of NASH into more aggressive phenotypes, including NASH fibrosis and NASH cirrhosis and eventually hepatocellular carcinoma (HCC), imposes a tremendous public health problem of epidemic proportions 1, 3…”

Nonalcoholic Fatty Liver Disease

“…This study also showed that patients who achieved greater than 7% weight loss had significantly greater improvements in all 3 components of the NASH activity score (steatosis, lobular inflammation, and ballooned hepatocytes) compared with those who lost less than 7% body weight. Therefore, aiming for a weight loss of 7% through diet and exercise appears to be a reasonable target in overweight and mildly obese patients [1,12].…”

“…Noninvasive biomarkers for diagnosis and staging of NAFLD and safe, cost-effective treatments for patients with nonalcoholic steatohepatitis (NASH) and/or NASH-related cirrhosis are currently under investigation. N onalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis, as demonstrated by imaging or histology, in the absence of significant alcohol consumption or other known secondary causes [1]. NAFLD is strongly associated with obesity and metabolic disturbances such as insulin resistance, type 2 diabetes mellitus, and dyslipidemia.…”

SCCA-IgM as a Potential Biomarker of Non-Alcoholic Fatty Liver Disease in Patients with Obesity, Prediabetes and Diabetes Undergoing Sleeve Gastrectomy

“…The diagnosis of NAFLD requires the exclusion of both secondary causes and a daily alcohol consumption ≥30 g for men and ≥20 g for women [1, 2]. The term NAFLD includes two pathologically distinct conditions with different prognoses: non-alcoholic fatty liver (NAFL) and NASH non-alcoholic steatohepatitis (NASH).…”

“…The identification of advanced fibrosis or cirrhosis is less accurate by current available biomarkers and needs to be confirmed by liver biopsy. Even if this procedure is essential for NASH diagnosis and able to discriminate between NAFL and NASH, it is costly and invasive, and thus not suitable for general population studies [1, 2, 5, 9]. For all these reasons there is an increasing need to develop non-invasive assessment to identify NAFLD in patients with increased metabolic risk and a worse prognosis.…”