Nonalcoholic Fatty Liver Disease and Recent Guideline Updates
Open accessAbstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States and in other industrialized nations.Its increase in prevalence and severity correlates with the rise in obesity and the metabolic syndrome, and NAFLD now represents a leading indication for liver transplantation in the United States. 1 The rising clinical and economic burden of NAFLD has highlighted the need for a streamlined approach to prevention, diagnosis, and treatment of the disease.In this review, we will summarize updated guideline and guidance recommendations for the management of adult NAFLD; highlight key difference between US, Asian, and European recommendations; and provide key updates. KeY UPDaTes TO Us GasTrOenTerOlOGY anD HePaTOlOGY sOCieTY reCOMMenDaTiOns FOr aDUlT naFlDIn 2012, the American Association for the Study of Liver Diseases (AASLD), the American College of Gastroenterology, and the American Gastroenterological Association published a joint practice guideline on NAFLD. 2 The diagnosis of NAFLD currently requires: (1) evidence of hepatic steatosis (HS) by imaging or histology, (2) no significant alcohol consumption, (3) no competing causes of HS, and (4) no coexisting causes of chronic liver disease.Research efforts have led to significant progress in our understanding of the disease.An updated practice guidance, based on expert consensus rather than by systematic review of the literature,
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Liver biopsy is the gold standard for diagnosing and grading NAFLD.
“Although liver biopsy is the gold standard for diagnosing and grading NAFLD, however, it can not be used as a screening tool [39].”
From Effectiveness of body roundness index for the prediction of nonalcoholic fatty liver disease: a systematic review and meta-analysis (2025) · cites this paper as [39]
In “How Should NAFLD Be Diagnosed, and How Should It Be Monitored?”, the review calls liver histology the gold standard for distinguishing steatohepatitis from simple steatosis and staging fibrosis. It also says biopsy should be considered only in select individuals because of its invasiveness and cost, supporting the screening limitation. It does not call biopsy the gold standard for diagnosing NAFLD generally; the review says diagnosis can use imaging or histology. (LLM, conf=0.84)
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Advancing the global public health agenda for NAFLD: a consensus statement
Lazarus, J. V., Mark, H. E., Anstee, Q. M., Arab, J. P., Batterham, R. L., Castera, L., Cortez-Pinto, H., Crespo, J., Cusi, K., Dirac, M. A., et al. (2022) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-021-00523-4 · Cited by 757 · see citing works
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NASH and Hepatocellular Carcinoma: Immunology and Immunotherapy
Pinter, M., Pinato, D. J., Ramadori, P., & Heikenwalder, M. (2023) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-21-1258 · Cited by 103 · see citing works
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Khanmohammadi, S., Fallahtafti, P., Habibzadeh, A., Ezzatollahi Tanha, A., Alamdari, A. A., Fallahtafti, P., & Shafi Kuchay, M. (2025) · Lipids in Health and Disease · doi:10.1186/s12944-025-02544-3 · Cited by 19 · see citing works
“Although liver biopsy is the gold standard for diagnosing and grading NAFLD, however, it can not be used as a screening tool [39].”
- Authors
- Ando, Y., & Jou, J. H.
- Affiliations
- Oregon Health and Science University Hospital (US)
- Portland VA Medical Center (US)
- Corresponding author
- Jou, Janice H.
- ORCID
- Jou, Janice H.
- Venue
- Clinical Liver Disease
- Published
- 2021-01
- Volume
- 17
- Issue
- 1
- Pages
- 23-28
- ISSN
- 2046-2484 (ISSN-L)
- PMC
- PMC7849298
- OpenAlex
- W3127981559
- Cited by
- 170
- References
- 1
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 38 · 2023: 48 · 2022: 42 · 2021: 20
- FWCI
- 26.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Clinical Liver Disease (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, guideline revision
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