TABLE 1.

Similarities and Differences in Guidelines from Europe, Asia, and the United States

	AASLD (2018)	EASL (2016)	Asia‐Pacific (2017)
Definition of significant alcohol consumption	Men: 21 standard drinks/week or 294 g/week Women: 14 standard drinks/week or 196 g/week	Men: 30 g/day Women: 20 g/day	Men: 2 standard drinks/day or 140 g/week Women: 1 standard drink/day or 70 g/week
Screening for NAFLD	Systematic screening of the general population not recommended
	No screening recommended due to lack of evidence of cost‐effectiveness to support screening even in high‐risk groups “Vigilance” in high‐risk groups	Recommend screening in patients with obesity, T2DM, MetS (A2) Recommend screening in patients with persistently abnormal liver enzymes (A1)	Consider screening in patients with obesity or T2DM (B2)
Fibrosis assessment	NFS, FIB‐4, and elastography No algorithm provided for preferred sequence of testing	NFS and FIB‐4 to risk‐stratify low versus medium/high risk for significant fibrosis Hepatology referral for medium/high‐risk patients for further testing with elastography and identifying those who need liver biopsy	No specific recommendation regarding preferred tests or algorithm
	Liver biopsy remains the gold standard for differentiating NAFL from NASH and staging liver fibrosis. Proceed with liver biopsy if: (1) suspicion for NAFLD advanced fibrosis (2), or concern for coexisting or competing etiology of chronic liver disease (B2).
Lifestyle intervention	Target weight loss of 7% to 10% TBW (B1). Achieve with 500‐1000 daily caloric deficit and moderate‐intensity exercise, preferably in a structured weight loss program (C2).
	No specific recommendations related to specific macronutrient diets or exercise regimens	Mediterranean diet, avoidance of processed foods and added fructose (B1)	No specific recommendations related to specific macronutrient diets or exercise regimens
Pharmacological intervention	There are currently no approved drugs to treat NAFLD or NASH. However, multiple drugs are in phase 3 development. In patients with cardiovascular indications, statins can be safely used in patients with NASH and compensated cirrhosis (B1)
	Vitamin E 800 IU daily can be considered in nondiabetic patients with biopsy‐proved NASH without cirrhosis Pioglitazone 30 mg daily can be considered in patients with and without T2DM with biopsy‐proved NASH	Pharmacotherapy should be reserved for patients with NASH fibrosis (stage F2 or higher) or NASH with high risk for disease progression (T2DM, MetS, elevated ALT) (B1) No firm recommendations can be made for the use of pioglitazone or vitamin E (B2)	Pioglitazone recommended only in patients with prediabetic or diabetic NASH for short‐term use (B2) No firm recommendation can be made regarding the use of vitamin E due to insufficient evidence (A2)

GRADE scores, when available, are listed in parentheses.