Figure 1.

Assessment and management of NAFLD. Patients with NAFLD typically come to the clinician’s attention due to elevated alanine aminotransferase (ALT) or steatosis on imaging usually done for unrelated indications. These patients should undergo evaluation to rule out alcoholic liver disease and etiologies other than NAFLD that could cause chronic liver disease. Diagnosis of NAFLD is confirmed using biochemical panels and imaging studies aimed at assessing steatosis and fibrosis. These confirmatory studies, together with NAFLD risk factors, are used for patient stratification into low-, intermediate-, and high-risk categories for liver-related outcomes. Recommendations are provided for management of patients in the different risk categories.

Notes: Cutoff values for APRI, FIB-4, and NFS are reported by Angulo et al.^{89 *}APRI formula: ((AST/AST upper limit of normal)/platelet [10⁹/L]) × 100.^{127 ‡}FIB-4 formula: (Age [years] × AST [U/L])/(platelet [10⁹/L] × √ALT [U/L]).^{128 #}NFS formula: −1.675 + 0.037 × age [years] + 0.094 × BMI [kg/m²] + 1.13 × hyperglycemia/diabetes [yes = 1, no = 0] + 0.99 × AST/ALT ratio − 0.013 × platelet [10⁹/L] − 0.66 × albumin [g/dL].¹²⁹

Abbreviations: ALT, alanine aminotransferase; APRI, aspartate aminotransferase to platelet ratio index; AST, aspartate aminotransferase; CBT, cognitive behavioral therapy; CT, computed tomography; CV, cardiovascular; FIB-4, fibrosis 4; Hep, hepatitis; HCC, hepatocellular carcinoma; MRI, magnetic resonance imaging; NAFLD, nonalcoholic fatty liver disease; NFS, NAFLD fibrosis score.