Researchers round up best practice advice for diagnosing and managing non-alcoholic fatty liver disease

(Boston)—Non-alcoholic fatty liver disease (NAFLD) is recognized as one of the leading causes of chronic liver disease, affecting more than 25% of the US and global population. One in four people with NAFLD have non-alcoholic steatohepatitis, a type of liver disease in which fat builds up in the livers of people who drink little or no alcohol, which is associated with morbidity and mortality significant due to complications of cirrhosis of the liver, hepatic decompensation (deterioration of liver function) and liver cancer.

Although NAFLD is mainly seen in people with obesity and/or type 2 diabetes mellitus (T2DM), an estimated 7-20% of people with NAFLD are lean. Unfortunately, limited guidance has been available for clinicians on appropriate clinical assessment in lean people with NAFLD so far.

The researchers have compiled a clinical practice update where they provide best practice advice on how to diagnose and manage non-alcoholic fatty liver disease in lean people.

Some of the 15 best practice guidance statements include:

  • Lean NAFLD should be diagnosed in people with NAFLD and a body mass index (BMI)
  • Lean people with NAFLD should be evaluated for comorbid conditions, such as T2DM, dyslipidemia (high cholesterol), and hypertension.
  • Lean people with NAFLD should be categorized by risk for hepatic fibrosis (excessive connective tissue in the liver) to identify those with advanced fibrosis or cirrhosis.
  • Lean individuals in the general population should not be routinely screened for NAFLD; however, screening should be considered for people over 40 with T2D.

According to the researchers, it is difficult to identify people with NAFLD who are at the highest risk of disease progression. “About 10 percent of people with NAFLD are underweight, and traditionally this group has been even more difficult to diagnose because the disease often goes unrecognized,” says Long, who is also a gastroenterologist at Boston Medical Center.

These results appear online in the journal Gastroenterology.

Dr. Long is supported in part by National Institute of Diabetes and Digestive and Kidney Diseases K23 DK113252, Doris Duke Charitable Foundation Grant #2019085, Gilead Sciences Research Scholars Award, Boston University School of Medicine Department of Medicine Career Investment Award, and the Institute for Clinical Translational Sciences at Boston University UL1 TR001430.

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