AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease

Abstract

The study of NAFLD has intensified significantly, with more than 1400 publications since 2018, when the last American Association for the Study of Liver Diseases (AASLD) Guidance document was published. [1] This new AASLD Guidance document reflects many advances in the field pertinent to any practitioner caring for patients with NAFLD and emphasizes advances in noninvasive risk stratification and therapeutics. A separate guideline focused on the management of patients with NAFLD in the context of diabetes has been written jointly by the American Association of Clinical Endocrinology and AASLD. [2] Given the significant growth in pediatric NAFLD, it will not be covered here to allow for a more robust discussion of the diagnosis and management of pediatric NAFLD in the upcoming AASLD Pediatric NAFLD Guidance. A "Guidance" differs from a "Guideline" in that it is not bound by the Grading of Recommendations, Assessment Development and Evaluation system. Thus, actionable statements rather than formal recommendations are provided herein. The highest available level of evidence was used to develop these statements, and, where high-level evidence was not available, expert opinion was used to develop guidance statements to inform clinical practice. Key points highlight important concepts relevant to understanding the disease and its management.The most profound advances in NAFLD relevant to clinical practice are in biomarkers and therapeutics. Biomarkers and noninvasive tests (NITs) can be used

Impact of Sex and Gender on Clinical Management of Patients with Advanced Chronic Liver Disease and Type 2 Diabetes

“…Due to its efficacy for NASH resolution and improvement of advanced fibrosis, current guidelines indicate pioglitazone for T2D patients with biopsy-proven NASH [ 111 ]. However, its effectiveness is highly variable, depending on the study populations, and some evidence suggests a greater metabolic benefit of pioglitazone in female patients.…”

Challenges and barriers in hepatocellular carcinoma (HCC) surveillance for patients with non-alcoholic fatty liver disease (NAFLD)

“…A retrospective study of almost 30,000 patients in Germany found that a FIB-4 score greater than or equal to 1.3 was a strong predictor of HCC over 10 years [16] . More recently, a cohort of 81,108 patients was assessed over a mean-follow up of 34 months, and FIB-4 independently predicted overall mortality and liver-related adverse outcomes [17] . For this reason, recent AASLD practice guidance recommends risk stratification with FIB-4 followed by transient elastography for patients with scores indicative of advanced fibrosis [18] .…”

Screening for At-Risk Nonalcoholic Fatty Liver Disease in the Primary Care Setting

“…Non-alcoholic fatty liver disease (NAFLD) is defined as hepatic steatosis without a secondary cause such as excess alcohol intake [1]. NAFLD is strongly associated with obesity, type 2 diabetes (T2DM), and the metabolic syndrome.…”

“…The underdiagnosis of at-risk NAFLD represents a major lost opportunity for early intervention before onset of cirrhosis and hepatic decompensation. Therefore, several professional societies have published guidelines for guidance on screening individuals at risk for at-risk NAFLD [1,[21][22][23]. In this review, we will describe features of at-risk NAFLD and review current screening guidelines and modalities.…”