NAFLD referral patterns in a large US academic center

A problem of proportions: estimates of metabolic associated fatty liver disease and liver fibrosis in Australian adults in the nationwide 2012 AusDiab Study

“…We used the BARD score which was able to be performed with the information available, and has been validated in multiple cohorts to perform similarly to the more widely known MAFLD fibrosis score 36 , 37 . These non-invasive markers tend to be sensitive but less specific for advanced fibrosis, and MAFLD alongside elevation of ALT is a more commonly used clinical trigger for specialist referral, as ALT elevation in MAFLD is associated with a higher risk of developing cirrhosis 11 , 38 . A significant proportion of our cohort were found to have MAFLD with an elevated ALT (8%), although the BARD score ruled out advanced fibrosis in 38% of those with MAFLD.…”

“…MAFLD is the most common cause of elevated aminotransferase levels in developed and developing countries, especially in primary care 7 – 10 . In particular, elevated serum alanine aminotransferase (ALT) levels account for a significant proportion of the indication for referrals to specialist liver services 11 . While elevated ALT indicates liver damage, it has also been shown in cross-sectional studies to correlate with obesity and features of the metabolic syndrome 12 , 13 .…”

Using Telehealth for Diagnosis and Management of Non‐Alcoholic Fatty Liver Disease

“…PCPs have a crucial role in diagnosis and management of NAFLD; however, lack of understanding remains an important barrier to link‐to‐care at‐risk patients 8,20 . Analysis of referrals trends at a tertiary care center showed that only 44/31934 (0.1%) of diabetic patients were referred to hepatology clinic for NAFLD 6 . This was much less than what is expected based on the pooled prevalence of NAFLD among diabetic patients in the United States (59.6%) 21 and can be attributed to lack of standardized referral algorithm and under recognition by PCPs or endocrinologists.…”

“…This was much less than what is expected based on the pooled prevalence of NAFLD among diabetic patients in the United States (59.6%) 21 and can be attributed to lack of standardized referral algorithm and under recognition by PCPs or endocrinologists. Furthermore, a significant proportion of the referrals were low‐risk patients (Fibrosis‐4 [FIB‐4] score < 1.3) who could essentially be managed by their PCPs 6 . Srivastava et al demonstrated that using a non‐invasive risk stratification model (FIB‐4) and subsequent transient elastography reduced unnecessary referrals by 80% and increased detection of advanced fibrosis by five5‐fold 7 …”

“…Furthermore, a significant proportion of the referrals were low-risk patients (Fibrosis-4 [FIB-4] score < 1.3) who could essentially be managed by their PCPs. 6 Srivastava et al demonstrated that using a non-invasive risk stratification model (FIB-4) and subsequent transient elastography reduced unnecessary referrals by 80% and increased detection of advanced fibrosis by five5-fold. 7 Telehealth encompasses a wide gamut of modalities 12,13 that can be potentially harnessed for the management of patients with NAFLD/NASH.…”