Non-alcoholic fatty liver disease screening

Non-Alcoholic Fatty Liver Disease Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Non-Alcoholic Fatty Liver Disease from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case studies
Case #1
Non-alcoholic fatty liver disease screening On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Non-alcoholic fatty liver disease screening All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Non-alcoholic fatty liver disease screening
CDC on Non-alcoholic fatty liver disease screening
Non-alcoholic fatty liver disease screening in the news
Blogs on Non-alcoholic fatty liver disease screening
Directions to Hospitals Treating Non-alcoholic fatty liver disease
Risk calculators and risk factors for Non-alcoholic fatty liver disease screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]Parth Vikram Singh, MBBS[3]

Overview

There is insufficient evidence to recommend routine screening for NAFLD in general population. However, screening is recommended in high-risk population groups(obesity, insulin resistance and patients with metabolic syndrome) as more than 50 million Americans have been estimated to have metabolic syndrome and about 80% of them have NAFD.

Screening

• There is insufficient evidence to recommend routine screening for NAFLD in general population.
• However, American Gastroenterological Association Technical Review recommends screening for non-alcoholic fatty liver disease in population at high risk such as obesity, insulin resistance, and metabolic syndrome.
• Screening is however complicated by the lack of accurate, noninvasive diagnostic tools for NAFLD and the lack of clear treatment that can be proposed to the patient.
• Current guidelines summarized in the JAMA review recommend a 2-tier testing approach to screen for advanced liver fibrosis in high-risk populations, including individuals with prediabetes or type 2 diabetes, obesity, 2 or more cardiometabolic risk factors, imaging-detected hepatic steatosis, or persistently elevated serum aminotransferase levels.
  • The first step is calculation of the Fibrosis-4 index, usually performed in primary care. Patients with a Fibrosis-4 index greater than 1.3 should undergo vibration-controlled transient elastography or another noninvasive test, such as the enhanced liver fibrosis test. Patients with liver stiffness greater than 8.0 kPa or an enhanced liver fibrosis test score greater than 9.8 should be referred to a hepatologist.
  • Patients with a FIB-4 score less than 1.3 should undergo lifestyle modification, avoidance of alcohol intake, and treatment of type 2 diabetes, obesity, dyslipidemia, and hypertension. Repeat FIB-4 testing may be performed every 1 to 3 years. Patients with indeterminate or high-risk findings should undergo additional noninvasive fibrosis assessment and may require hepatology referral.

FIB-4 score	Interpretation
<1.30	Low risk of advanced fibrosis
1.30-2.67	Indeterminate risk of advanced fibrosis
>2.67	High risk of advanced fibrosis

The AGA also recommends screening.

Workflows to promote screening may increase treatment.

Screening modalities

• Serum tests of liver function