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Current 23 - Update on the Diagnosis and Management of Nonalcoholic Fatty Liver Disease



Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. A 2022 Clinical Practice Guideline from the American Association of Clinical Endocrinology and the American Association for the Study of Liver Diseases provides screening, diagnosis, and management algorithms for NAFLD.1  Early diagnosis in the primary care setting is important to reduce disease progression.

NAFLD is associated with obesity, insulin resistance, type 2 diabetes (T2D), hypertension, and dyslipidemia, and is an independent risk factor for cardiovascular disease.  Approximately 60-70% of patients with T2D have NAFLD, with many having aminotransferases in normal ranges, and 15% have clinically significant fibrosis.3  Screening for clinically significant fibrosis with FIB-4 index is recommended in patients with T2D or pre-diabetes, obesity and/or metabolic syndrome, and those with persistently elevated aminotransferases or hepatic steatosis seen on imaging (Figure 1). While there are no FDA-approved treatments, NAFLD can be managed with weight reduction and pharmacotherapy (Figures 3-6).


  1. Cusi K, Isaacs S, Barb D, et al. 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;28(5):528-562. doi:10.1016/j.eprac.2022.03.010.
  2. Ye Q, Zou B, Yeo YH, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(8):739-752. doi:10.1016/S2468-1253(20)30077-7.
  3.  Lomonaco R, Godinez Leiva E, Bril F, et al. Advanced liver fibrosis is common in patients with type 2 diabetes followed in the outpatient setting: the need for systematic screening. Diabetes Care. 2021;44(2):399-406. doi:10.1016/j.eprac.2022.03.010.doi:10.2337/dc20-1997.


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