Diagnosis and Management of Nonalcoholic Fatty Liver Disease
Peggy B. Leung, MD; Andrew M. Davis, MD, MPH; Sonal Kumar, MD, MPH
GUIDELINE TITLE American Association of Clinical Endocrinology (AACE) Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings RELEASE DATE May 2022 DEVELOPER AND FUNDING SOURCE AACE and American Association for the Study of Liver Diseases (AASLD) TARGET POPULATION Patients at risk of non-alcohol fatty liver disease (NAFLD) MAJOR RECOMMENDATIONS • Screen persons with (1) prediabetes or type 2 diabetes, (2) obesity or 2 cardiometabolic risk factors, and/or (3) abnormal serum aminotransaminases or hepatic steatosis on imaging for NAFLD and advanced fibrosis (grade B; intermediate/high strength of evidence [SOE]). • Use noninvasive liver fibrosis clinical prediction tools like the Fibrosis-4 Index (FIB-4) to initially assess risk of NAFLD and liver fibrosis (grade B; intermediate SOE). • Evaluate risk of fibrosis in persons with NAFLD with vibration-controlled transient elastography (VCTE) or enhanced liver fibrosis (ELF) score (grade B; intermediate SOE). • Refer patients to specialists when there are persistently elevated aminotransferases or hepatic steatosis on imaging with indeterminate or high-risk noninvasive results (FIB-4 >1.3, elevated liver stiffness measurement, or positive ELF results) (grade B; intermediate SOE). • Treat cardiometabolic disease in persons with NAFLD (grade A; high/intermediate SOE). • Recommend dietary modification and physical activity (150 min/wk) in persons with excess adiposity and NAFLD (grade A; intermediate SOE). • Initiate pioglitazone and/or glucagon-like peptide 1 receptor agonists (GLP1RAs), especially in type 2 diabetes and biopsyproven nonalcoholic steatohepatitis (NASH), and strongly consider adjunctive obesity pharmacotherapy with lifestyle modifications for individuals with obesity, diabetes, and NAFLD (grade A; high/intermediate SOE). • Consider bariatric surgery to treat NAFLD in persons with a body mass index >35 (grade B; intermediate/weak SOE).