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Screening, Diagnosis, and Staging of Non-Alcoholic Fatty Liver Disease (NAFLD): Application of Society Guidelines to Clinical Practice

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Abstract

Purpose of Review

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease (NAFLD), is the most common chronic liver disease affecting 30% of the global population. In this article, we summarize current expert guidelines, review clinical practice implications, and provide insight into the utility of non-invasive tests (NITs).

Recent Findings

The burden of MASLD is growing with the obesity epidemic, yet disease awareness and diagnosis is low. Patients can progress to metabolic dysfunction-associated steatohepatitis (MASH, formerly NASH), which can advance to liver fibrosis, cirrhosis, hepatic decompensation, and liver cancer. NITs help identify high-risk patients who may benefit from specialty referral and MASH-directed therapy.

Summary

Global societies offer various recommendations for the screening and diagnosis of MASLD utilizing evidence-based, widely accessible methods such as serum indices, NITs, and liver biopsy. Several targeted steatotic liver disease (SLD) screening tools and novel therapies are under development.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

AGA:

American Gastroenterological Association

ADA:

American Diabetes Association

AACE:

Association of Clinical Endocrinology

ALEH:

Latin American Association for the Study of the Liver

APASL:

Asian Pacific Association for the Study of the Liver

EASL:

European Association for the Study of the Liver

EASD:

European Association for the Study of Diabetes

EASO:

European Association for the Study of Obesity

US:

Abdominal ultrasound

CT:

Computed tomography

BMI:

Body mass index

ELF:

Enhanced Liver Fibrosis

FIB-4:

Fibrosis-4

HCC:

Hepatocellular carcinoma

MAFLD:

Metabolic (dysfunction)-associated fatty liver disease

MASLD:

Metabolic dysfunction-associated steatotic liver disease

MASH:

Metabolic dysfunction-associated steatohepatitis

MRE:

Magnetic resonance elastography

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

NFS:

Nonalcoholic fatty liver disease fibrosis score

NIT:

Noninvasive test

T2DM:

Type 2 diabetes mellitus

TE:

Transient elastography

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Authors and Affiliations

  1. Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA

    Ysabel C. Ilagan-Ying, Bubu A. Banini, Albert Do, Robert Lam & Joseph K. Lim

  2. Yale Liver Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA

    Bubu A. Banini, Albert Do, Robert Lam & Joseph K. Lim

  3. Section of Digestive Diseases and Liver Center, 333 Cedar Street, LMP 1080, New Haven, CT, 06520, USA

    Joseph K. Lim

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Contributions

YIY wrote the main manuscript text. YIY and RL prepared Tables 1, 2, and 3. BAB, D, RL, and JKL reviewed and revised the manuscript.

Corresponding author

Correspondence to Joseph K. Lim.

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Competing Interests

JKL has received research contracts (to institution) from Genfit, Gilead, Intercept, Inventiva, Pfizer, and Viking. All other authors report no competing interests.

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The authors declare no competing interests.

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Ilagan-Ying, Y.C., Banini, B.A., Do, A. et al. Screening, Diagnosis, and Staging of Non-Alcoholic Fatty Liver Disease (NAFLD): Application of Society Guidelines to Clinical Practice. Curr Gastroenterol Rep 25, 213–224 (2023). https://doi.org/10.1007/s11894-023-00883-8

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