U.S. clinical guidelines for the management of patients with nonalcoholic fatty liver disease are published
The American Association of Clinical Endocrinologists together with the American Association for the Study of Liver Diseases (AACE and AASLD) have published clinical guidelines for the identification and further management of patients with nonalcoholic fatty liver disease in the journal Endocrine Practic, primarily for internists and endocrinologists.The new guidelines are aimed at early diagnosis of the disease by screening patients at high risk of developing the disease: those with prediabetes, type 2 diabetes, obesity, two or more cardiometabolic risk factors, with liver steatosis and a long-term increase in aminotransferases (more than 6 months).
For screening, it is recommended to use the fibrosis index (FIB-4), which is calculated taking into account the patient's age, AST, ALT, and platelet counts. According to the value obtained, patients are divided into liver fibrosis risk groups.
Patients in the low-risk group are indicated for further follow-up with a physician and treatment aimed at weight loss and prevention of cardiovascular disease. In the intermediate risk group, additional noninvasive examinations such as elastography or the enhanced liver fibrosis (ELF) test are recommended. Patients at high risk of fibrosis should be referred to a hepatologist for further investigations, including liver biopsy.
Treatment includes lifestyle changes, cardiovascular risk reduction, weight loss, including medication, and bariatric treatment. There is no specific treatment for nonalcoholic fatty liver disease, but pioglitazone, which is used for type 2 diabetes, and glucagon-like peptide-1 receptor agonists, which are approved for type 2 diabetes and weight loss, have been shown to be effective.