Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings
Patient Guideline Summary
Publication Date: May 1, 2022
This patient summary means to discuss key recommendations from the American Association of Clinical Endocrinology (AACE) and the American Association for the Study of Liver Diseases (AASLD) for Nonalcoholic Fatty Liver Disease. It is limited to adults 18 years of age and older and should not be used as a reference for children.
- Nonalcoholic fatty liver disease (NAFLD) is a medical condition where the liver contains too much fat. In a recent United States study, 38% of the older population had NAFLD. Of that 38%, slightly over a third had a more dangerous form, known as nonalcoholic steatohepatitis (NASH). NASH can progress to advanced liver fibrosis, cirrhosis, or liver cancer.
- We will use multiple abbreviations throughout this summary that can be found at the end of the page.
- There are no known causes for nonalcoholic fatty liver disease, but it is closely associated with obesity, insulin resistance, type 2 diabetes mellitus (T2D), hypertension, and atherogenic dyslipidemia (cholesterol problems).
- This patient summary focuses on the diagnosis and management of the non-alcohol-induced fatty liver disease.
Diagnosis, like the disease, is progressive. Each positive step recommends the next step. A typical series of tests like the one below may be modified by your doctor, depending on your individual circumstances.
- Step 1: Identify high-risk persons
- Elements of the metabolic syndrome
- abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein
- Prediabetes or type 2 diabetes
- Hepatic steatosis on an imaging study
- Elevated liver function blood tests
- Bariatric surgery patients
- Adolescent females with polycystic ovary syndrome
- Step 2: Perform a Fibrosis-4 (FIB-4) Calculation (based on 2 liver function tests [AST and ALT], a platelet count, and the person’s age)
- Step 3: Perform a liver stiffness measurement (LSM) by transient elastography or an enhanced liver fibrosis test (ELF) test
- Step 4: Perform vibration-controlled transient elastography (VCTE).
- Other tests are not preferred.
- Signs of serious disease suggest you be managed by a gastroenterologist or hepatologist.
- All conditions must be managed at the same time since they are closely related.
- There are no U.S. Food and Drug Administration-approved medications for the treatment of NAFLD. However, some diabetes and anti-obesity medications can be beneficial.
- Bariatric surgery is also effective for weight loss and reducing liver fat in persons with severe obesity, but patients must be carefully screened for suitability.
- Weight loss
- Diet modification
- Physical activity
- Pioglitazone and GLP-1 RAs for T2D and biopsy-proven NASH.
- GLP-1 RAs for children with obesity and T2D
- Semaglutide 2.4 mg/week (best evidence) or liraglutide 3 mg/day.
- AACE: American Association Of Clinical Endocrinology
- AASLD: American Association For The Study Of Liver Diseases
- ALT: Alanine Aminotransferase
- AST: Aspartate Aminotransferase
- ELF: Enhanced Liver Fibrosis
- FIB-4: Fibrosis-4 Index
- GLP-1 RA: Glucagon-like Peptide-1 Receptor Agonist
- GLP-1 RAs: Glucagon-like Peptide-1 Receptor Agonists
- LSM: Liver Stiffness Measurement
- NAFLD: Non-alcoholic Fatty Liver Disease
- NASH: Nonalcoholic Steatohepatitis
- SGLT-2: Sodium-glucose Co-transporter-2
- T1D: Type 1 Diabetes
- T2D: Type 2 Diabetes
- VCTE: Vibration-controlled Transient Elastography
Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, Kashyap S, Mechanick JI, Mouzaki M, Nadolsky K, Rinella ME, Vos MB, Younossi Z. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022 May;28(5):528-562. doi: 10.1016/j.eprac.2022.03.010. PMID: 35569886.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.