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(1)
Non-specific hepatic ultrasound may miss NAFLD with liver fat content < 20%.
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(2)
Vibration-controlled transient elastography (VCTE or Fibroscan) is a non-invasive ultrasound technique that can measure controlled attenuation parameter (CAP), which is a measure of hepatic steatosis. VCTE can also measure hepatic “stiffness,” which reflects congestion, inflammation, and hepatic fibrosis.
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(3)
Hepatic computed tomography (CT) has limited use in clinical practice due to radiation exposure that exceeds other liver fat imaging studies.
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(4)
Magnetic resonance imaging is commonly used to measure liver fat, via proton density fat fraction (MRI-PDFF) which can assess the entire liver and that can be used with multiple MRI platforms.
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(5)
Magnetic resonance spectroscopy (MRS) can measure fat in small regions of interest; but not all MRI platforms have the capability to perform MRS.
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(6)
Nutritional medical therapy directed towards reducing imaging presence of hepatic fat (NAFLD) are similar to a heart healthy diet, such as evidenced-based meal plans limiting saturated fats and limiting ultra -processed/refined carbohydrates (e.g., Mediterranean diet). [1]
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(7)
Longitudinal hepatic imaging in patients with NAFD may help track progress of therapy, [160] such as after implementation of appropriate nutrition, as well as dynamic and resistance training that increases peripheral insulin sensitivity, reduce circulating free fatty acids and glucose, reduce lipotoxicity, increase hepatic fatty-acid oxidation, decrease fatty acid synthesis, and that may help prevent mitochondrial and hepatocellular damage. [161]
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(8)
Among patients with overweight or obesity, weight loss of 3 – 5% may reduce hepatic imaging consistent with steatosis, with weight loss of 7 – 10% usually needed to improve histopathological features of NASH (e.g., fibrosis).
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(9)
No pharmacotherapy has an approved indication to treat NAFLD and reduce imaging findings of liver fat. However, vitamin E 800 IU may provide biochemical and histological improvement in fatty liver in some adult patients with NASH without diabetes mellitus.
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(10)
Some drugs may reduce imaging findings of hepatic fat such as peroxisome proliferator activated receptor gamma agonists and glucagon like protein – 1 receptor agonists.
