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AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease
Open accessAbstract
PREAMBLE The study of NAFLD has intensified significantly, with more than 1400 publications since 2018, when the last American Association for the Study of Liver Diseases (AASLD) Guidance document was published.1 This new AASLD Guidance document reflects many advances in the field pertinent to any practitioner caring for patients with NAFLD and emphasizes advances in noninvasive risk stratification and therapeutics. A separate guideline focused on the management of patients with NAFLD in the context of diabetes has been written jointly by the American Association of Clinical Endocrinology and AASLD.2 Given the significant growth in pediatric NAFLD, it will not be covered here to allow for a more robust discussion of the diagnosis and management of pediatric NAFLD in the upcoming AASLD Pediatric NAFLD Guidance. A “Guidance” differs from a “Guideline” in that it is not bound by the Grading of Recommendations, Assessment Development and Evaluation system. Thus, actionable statements rather than formal recommendations are provided herein. The highest available level of evidence was used to develop these statements, and, where high-level evidence was not available, expert opinion was used to develop guidance statements to inform clinical practice. Key points highlight important concepts relevant to understanding the disease and its management. The most profound advances in NAFLD relevant to clinical practice are in biomarkers and therapeutics. Biomarkers and noninvasive tests (NITs) can be used clinically to either exclude advanced diseases or identify those with a high probability of cirrhosis.3,4 NIT “cut points” vary with the populations studied, underlying disease severity, and clinical setting. Those proposed in this guidance are meant to aid decision-making in the clinic and are not meant to be interpreted in isolation. Identifying patients with “at-risk” NASH (biopsy-proven NASH with stage 2 or higher fibrosis) is a more recent area of interest. Although the definitive diagnosis and staging of NASH remain linked to histology, noninvasive tools can now be used to assess the likelihood of significant fibrosis, predict risk of disease progression and decompensation, make management decisions, and, to some degree, assess response to treatment. There is an ongoing debate over the nomenclature of fatty liver disease, which had not been finalized at the time this guidance was published. At the culmination of a rigorous consensus process, it is intended that any formal change in nomenclature will advance the field without a negative impact on disease awareness, clinical trial endpoints, or the drug development/approval process. Furthermore, it should allow for the emergence of newly recognized disease subtypes to address the impact of disease heterogeneity, including the role of alcohol, on disease progression and response to therapy. Input from patients has been central to all stages of the consensus process to ensure the minimization of nomenclature-related stigma. DEFINITIONS NAFLD is an overarching term that includes all disease grades and stages and refers to a population in which ≥5% of hepatocytes display macrovesicular steatosis in the absence of a readily identified alternative cause of steatosis (eg, medications, starvation, monogenic disorders) in individuals who drink little or no alcohol (defined as < 20 g/d for women and <30 g/d for men). The spectrum of disease includes NAFL, characterized by macrovesicular hepatic steatosis that may be accompanied by mild inflammation, and NASH, which is additionally characterized by the presence of inflammation and cellular injury (ballooning), with or without fibrosis, and finally cirrhosis, which is characterized by bands of fibrous septa leading to the formation of cirrhotic nodules, in which the earlier features of NASH may no longer be fully appreciated on a liver biopsy. UPDATE ON EPIDEMIOLOGY AND NATURAL HISTORY The prevalence of NAFLD and NASH is rising worldwide in parallel with increases in the prevalence of obesity and metabolic comorbid disease (insulin resistance, dyslipidemia, central obesity, and hypertension).5,6 The prevalence of NAFLD in adults is estimated to be 25%–30% in the general population7–9 and varies with the clinical setting, race/ethnicity, and geographic region studied but often remains undiagnosed.10–14 The associated economic burden attributable to NASH is substantial.15–17 The prevalence of NASH in the general population is challenging to determine with certainty; however, NASH was identified in 14% of asymptomatic patients undergoing colon cancer screening.14 This study also highlights that since the publication of a prior prospective prevalence study,18 the prevalence of clinically significant fibrosis (stage 2 or higher fibrosis) has increased >2-fold. This is supported by the projected rise in NAFLD prevalence by 2030, when patients with advanced hepatic fibrosis, defined as bridging fibrosis (F3) or compensated will the proj
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“Based on this, it seems reasonable to conclude that should patients continue to complete guideline-based amounts of aerobic exercise over a longer duration, fibrosis improvement may follow [35, 36].”
From Aerobic Exercise Training Leads to MASH Resolution as Defined by the MASH Resolution Index (2026) · cites this paper as [35]
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“Moreover, interventions in diet and physical activity are considered to be the cornerstone of management in the whole MASLD spectrum [7, 10].”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [7]
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In the citing paper
“Although there is no consensus on the optimal diet for treating MASLD, the EASL-EASD-EASO guidelines recently recommended the MD as the preferred option [7, 10].”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [7]
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“Current guidelines recommend weight loss through dietary modifications, increased physical activity, or both combined in MASLD patients [7, 11, 12].”
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“Various scienti fi c societies have recommended clinical care pathways with an emphasis on the use of non-invasive tests (NITs) and the liaison between primary care/non-hepatology and hepatology settings.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [126]
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“GLP-1RA-based drugs have been proven beneficial to some extent in dedicated trials and should be considered in patients with obesity and/or T2D and metabolic dysfunction-associated steatohepatitis (MASH)90.”
From Incretin-based therapies for the treatment of obesity-related diseases (2024) · cites this paper as [90]
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The Janus of a disease: Diabetes and metabolic dysfunction-associated fatty liver disease
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“These tests are useful in scenarios where there are access limitations for image-based NITs [65].”
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MASLD: Prevalence, Mechanisms, and Sex-Based Therapies in Postmenopausal Women
Milani, I., Chinucci, M., Leonetti, F., & Capoccia, D. (2025) · Biomedicines · doi:10.3390/biomedicines13040855 · Cited by 38
Hepatic Fibrosis and Cancer: The Silent Threats of Metabolic Syndrome
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“Based on the strong association between T2DM and MASLD, the American Diabetes Association [20] and the American Association for the Study of Liver Diseases [21] have recommended screening all patients with T2DM for the presence of MASLD or MASH.”
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A roadmap for clinical trials in MASH-related compensated cirrhosis
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“Lifestyle changes, such as diets low in refined sugars and unsaturated fats, physical exercise 26–28 , and weight loss (through diet and exercise, bariatric surgery, or the use of glucagon-like peptide 1 (GLP1) receptor agonists and dual or triple glucagon agonists), are at the core of current…”
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“6,9 In this review, we will briefly review the current indications for liver biopsy, technique, and associated safety.”
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Targeting PNPLA3 to Treat MASH and MASH Related Fibrosis and Cirrhosis
Lindén, D., Tesz, G. J., & Loomba, R. S. (2024) · Liver International · doi:10.1111/liv.16186 · Cited by 36
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“[20] The prevalence of advanced fibrosis in high-risk MASLD populations ranges from 4% to 33%, [57] with our study population showing a prevalence of 17.9%.”
Influentialde Souza, M. H. G., Al‐Sharif, L., Diaz, I., Mantovani, A., & Villela‐Nogueira, C. A. (2024) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2024.102495 · Cited by 39
Pharmacological treatment of MASLD: contemporary treatment and future perspectives
Drygalski, K. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26136518 · Cited by 39
“RCTs, including PIVENS, have shown histological improvements in steatosis, lobular inflammation, and hepatocellular ballooning in patients with MASH, especially those with T2DM [13,15,38–40].”
InfluentialEndpoints in NASH Clinical Trials: Are We Blind in One Eye?
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“Recent hepatological and endocrinological guidelines recommended initiating pioglitazone and/or GLP-1 receptor agonists, especially in patients with biopsy-proven NASH and T2D [164,165].”
BackgroundPractical Lifestyle Management of Nonalcoholic Fatty Liver Disease for Busy Clinicians
Zelber‐Sagi, S., & Moore, J. B. (2024) · Diabetes Spectrum · doi:10.2337/dsi23-0009 · Cited by 39
“Therefore, this diet and overlapping dietary patterns are recommended by all relevant clinical practice guidelines (9 – 12 The two largest and longest RCTs (18 months each) have provided the best evidence for the valuable role of two modi fi ed Mediterranean diets.”
BackgroundHuang, D. Q., Wilson, L., Behling, C. A., Amangurbanova, M., Kleiner, D. E., Kowdley, K. V., Dasarathy, S., Terrault, N. A., Diehl, A. M., Chalasani, N., et al. (2024) · Hepatology · doi:10.1097/hep.0000000000001015 · Cited by 39
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Associations between types and sources of dietary carbohydrates and liver fat: a UK Biobank study
Orliacq, J., Perez‐Cornago, A., Parry, S. A., Kelly, R. K., Koutoukidis, D. A., & Carter, J. L. (2023) · BMC Medicine · doi:10.1186/s12916-023-03135-8 · Cited by 33
“This disease is characterised by the accumulation of fat in the liver [5] and can progress from simple steatosis ( ≥ 5.”
BackgroundPerformance of non-invasive tests for liver fibrosis resolution after bariatric surgery
Raverdy, V., Tavaglione, F., Chatelain, E., Caiazzo, R. J., Saponaro, C., Lassailly, G., Verkindt, H., Baud, G., Marciniak, C., Chetboun, M., et al. (2024) · Metabolism · doi:10.1016/j.metabol.2024.155790 · Cited by 33
MASLD and MASH at the crossroads of hepatology trials and cardiorenal metabolic trials
Zannad, F. M., Sanyal, A. J., Butler, J., Ferreira, J. P., Girerd, N., Miller, V., Pandey, A., Parikh, C. R., Ratziu, V., Younossi, Z. M., et al. (2024) · Journal of Internal Medicine · doi:10.1111/joim.13793 · Cited by 38
“In addition, surgical and non-surgical weight loss have demonstrated beneficial effects in patients with NAFLD/NASH, CVD, T2DM, and CKD [55–58].”
BackgroundA novel molecular pathway of lipid accumulation in human hepatocytes caused by PFOA and PFOS
Gou, X., Tian, M., Yan, L., Xia, P., Ji, H., Tan, H., Shi, W. M., Yu, H., & Zhang, X. (2024) · Environment International · doi:10.1016/j.envint.2024.108962 · Cited by 37
Boeckmans, J., Prochaska, J. H., Gieswinkel, A., Böhm, M., Wild, P. S., & Schattenberg, J. M. (2024) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2024.101153 · Cited by 34
“Another factor that could explain the predictive ability of the FIB-4 index for mortality and its association with cardiac dysfunction in the absence of MASLD is increased portal pressure in advanced congestive hepatopathy, which adds hemodynamic failure to the already existing relative hypovolemia in HF. 26 – 28 As a…”
InfluentialMetALD : New Perspectives on an Old Overlooked Disease
Ayares, G., Díaz, L. A., Idalsoaga, F. J., Alkhouri, N., Noureddin, M., Bataller, R. A., Loomba, R. S., Arab, J. P., & Arrese, M. A. (2025) · Liver International · doi:10.1111/liv.70017 · Cited by 34
Self-citationIvancovsky Wajcman, D., Byrne, C. J., Dillon, J. F., Brennan, P. N., Villota-Rivas, M., Younossi, Z. M., Allen, A. M., Crespo, J., Gerber, L. H., & Lazarus, J. V. (2026) · Hepatology · doi:10.1097/hep.0000000000001058 · Cited by 33
“The most adopted recommendation (n = 12), supported by AACE, [33] AASLD, [36] ALEH, [34] and the EASL patient guideline, [44] states that only patients living with advanced disease should avoid alcohol consumption, while others may stay within the recommended daily limit of 30 g for men and 20 g…”
InfluentialKakegawa, T., Sugimoto, K., Saito, K., Yunaiyama, D., Araki, Y., Wada, T., Takahashi, H., Yoshimasu, Y., Takeuchi, H., & Itoi, T. (2024) · Medicine · doi:10.1097/md.0000000000038444 · Cited by 32
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Wang, Y., Song, S. J., Jiang, Y., Lai, J. C., Wong, G. L., Wong, V. W., & Yip, T. C. (2024) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2024.0246 · Cited by 32
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Metabolic Dysfunction and Alcohol-Associated Liver Disease: A Narrative Review
Dunn, N. R., Alkhouri, N., Ismail, A. S., & Singal, A. K. (2025) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000828 · Cited by 32
Bailey, C. J., Flatt, P. R., & Conlon, J. M. (2025) · Peptides · doi:10.1016/j.peptides.2025.171380 · Cited by 36
“…of non-alcoholic fatty liver disease into metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH) has been accompanied by the inclusion of GLP-1RAs into guidelines as potentially useful for prevention and treatment [74 – 77].”
Kim, H. Y., & Rinella, M. E. (2025) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2025.0083 · Cited by 36
Self-citationHarris, S. J., Smith, N., Hummer, B., Schreibman, I. R., Faust, A. J., Geyer, N. R., Chinchilli, V. M., Sciamanna, C., Loomba, R., & Stine, J. G. (2024) · Liver International · doi:10.1111/liv.15769 · Cited by 31
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A promising therapy for fatty liver disease: PCSK9 inhibitors
Han, L., Wu, L., Yin, Q., Li, L., Zheng, X., Du, S., Huang, X., Bai, L., Wang, Y., & Bian, Y. (2024) · Phytomedicine · doi:10.1016/j.phymed.2024.155505 · Cited by 31
Choochuay, K., Kunhapan, P., Puangpetch, A., Tongsima, S., Srisawasdi, P., Sobhonslidsuk, A., Sungkanuparph, S., Biswas, M., & Sukasem, C. (2024) · World Journal of Hepatology · doi:10.4254/wjh.v16.i3.452 · Cited by 39
“Genes have been identified as modulators of insulin sensitivity and regulators of the intracellular flow of fatty acids, TG, oxidative stress, endotoxin response, cytokine activity, and the development of fibrosis[18].”
Tsochatzis, E. A., Valenti, L. V. C., Thiele, M. S., Péloquin, S., Lazure, P., Masson, M. H., Allen, A. M., Lazarus, J. V., Noureddin, M., Rinella, M. E., et al. (2024) · Liver International · doi:10.1111/liv.15941 · Cited by 31
“37,40 These preventative and therapeutic lifestyle interventions will remain key in the management of liver diseases in the future, even after medical therapies become available in the field.”
Self-citationBrahmania, M., Rogal, S. S., Serper, M., Patel, A., Goldberg, D. S., Mathur, A. K., Wilder, J. M., Vittorio, J., Yeoman, A. D., Rich, N. E., et al. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000413 · Cited by 31
“11 – 13] However, these guidelines do not consider how vulnerable populations can be at a higher risk of disease and may be appropriate for increased or more targeted screening.”
Recompensation in MASLD-related cirrhosis via metabolic bariatric surgery
Feng, G., Han, Y., Yang, W., Shikora, S. A., Mahawar, K. K., Cheung, T. T., Targher, G., Byrne, C. D., Hernández–Gea, V., Tilg, H., et al. (2024) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2024.05.009 · Cited by 31
Han, J. W., Kim, H. Y., Yu, J. H., Kim, M. N., Chon, Y. E., An, J., Jin, Y., Choi, M., Kim, S. U., Lee, H. A., et al. (2024) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2024.0330 · Cited by 31
MASLD: What We Have Learned and Where We Need to Go-A Call to Action.
Shabanan, S. H., Martins, V. F., Wolfson, T., Weeks, J., Ceriani, L., Behling, C., Chernyak, V., Kaffas, A. E., Borhani, A., Han, A.-G., et al. (2024) · Radiographics · doi:10.1148/rg.240048 · Cited by 32
Oliveira, L. S. D., & Ritter, M. J. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000596 · Cited by 33
“If 18 – 20] While there continues to be a robust area of research into drug treatment for MASLD, currently there is only 1 (recently) approved pharmacological therapy, resme-tirom, a THR agonist.”
Liver Cirrhosis: Evolving Definitions, and Recent Advances in Diagnosis, Prevention and Management
Battle, A. R., Mudd, J., Ahlenstiel, G., & Kalo, E. (2025) · Livers · doi:10.3390/livers5030028 · Cited by 32
Clinical trial design, biomarkers and end points in metabolic and alcohol-related liver disease
Díaz, L. A., Thiele, M. S., Louvet, A., Lee, B. P., Ajmera, V. H., Tavaglione, F., Hsu, C. L., Huang, D. Q., Pose, E., Bataller, R. A., et al. (2025) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-025-01120-5 · Cited by 33
“All patients should undergo nutritional assessment 152 , and a plan should be established for regular follow-up.”
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Endogenous sex hormones and nonalcoholic fatty liver disease in US adults
Kim, D., Manikat, R., Cholankeril, G. T., & Ahmed, A. (2023) · Liver International · doi:10.1111/liv.15786 · Cited by 30
“6 Although lifestyle modifications such as weight loss and increasing physical activity are the cornerstones of NAFLD prevention, 6 efforts are needed to understand other risk factors of NAFLD better and develop additional preventive strategies.”
BackgroundBarchetta, I., Cimini, F. A., Sentinelli, F., Chiappetta, C., Cristofano, C. D., Silecchia, G., Leonetti, F., Baroni, M. G., & Cavallo, M. G. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms242417174 · Cited by 30
“However, its pathogenesis remains unclear, and validated therapies are lacking, aside from lifestyle interventions [6].”
BackgroundThe Relationship between Pathogenesis and Possible Treatments for the MASLD-Cirrhosis Spectrum
Vidal‐Cevallos, P., Sorroza-Martínez, A. P., Chávez-Tapia, N. C., Uribe, M., Montalvo-Jave, E. E., & Nuño‐Lámbarri, N. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25084397 · Cited by 32
“Omega-3 fatty acid supplementation effectively treats triglyceride-dominated dys-lipidemias in patients with MASLD in combination with lifestyle changes; however, its use to reduce intrahepatic fat has no currently established benefits [95].”
BackgroundInfluentialAlkhouri, N., Charlton, M., Gray, M. E., & Noureddin, M. (2025) · Expert Opinion on Investigational Drugs · doi:10.1080/13543784.2025.2473062 · Cited by 32
“MASLD is a complex, systemic disease that affects multiple body systems [2,3].”
InfluentialLai, J. C., Yang, B., Lee, H. W., Lin, H., Tsochatzis, E. A., Petta, S., Bugianesi, E., Yoneda, M., Zheng, M., Hagström, H., et al. (2025) · Gut · doi:10.1136/gutjnl-2025-334981 · Cited by 32
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“4 8 The widespread use of GLP-1RAs has raised concerns about their safety profile.”
Musso, G., Pinach, S., Mariano, F., Saba, F., De Michieli, F., Framarin, L., Berrutti, M., Paschetta, E., Parente, R., Lizet Castillo, Y., et al. (2025) · Hepatology · doi:10.1097/hep.0000000000000937 · Cited by 31
Haber, R., Zarzour, F., Ghezzawi, M., Saadeh, N., Bacha, D. S., Jebbawi, L. A., Chakhtoura, M., & Mantzoros, C. S. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15501 · Cited by 35
“The results for change in lipid parameters are described here in the main text, while the results on the achieved levels of these parameters can be found in Table S5.”
Sung, S., Al‐Karaghouli, M., Tam, M., Wong, Y. J., Jayakumar, S., Davyduke, T., Ma, M. M., & Abraldeṣ, J. G. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000609 · Cited by 30
Ünalp–Arida, A., & Ruhl, C. E. (2024) · Hepatology · doi:10.1097/hep.0000000000001211 · Cited by 33
Prevalence and predictors of cirrhosis and portal hypertension in the United States
Younossi, Z. M., de Avila, L., Racila, A., Nader, F., Paik, J. M., Henry, L. L., & Stepanova, M. (2025) · Hepatology · doi:10.1097/hep.0000000000001243 · Cited by 29
Anania, F. A., Hager, R., Higgins, K. M., Makar, G. A., Siegel, J. N., & Tran, T. T. (2025) · Hepatology · doi:10.1097/hep.0000000000001509 · Cited by 31
MASLD, MASH, and the CKM Spectrum
Zannad, F. M., Khan, M. S., Bansal, N., Böhm, M., Francque, S., Girerd, N., Januzzi, J. L., Miller, V., Piché, M., Ratziu, V., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2025.12.015 · Cited by 33
Lee, S. W., Huang, D. Q., Bettencourt, R., Ajmera, V. H., Tincopa, M. A., Noureddin, N., Amangurbanova, M., Siddiqi, H., Madamba, E. V., Majzoub, A. M., et al. (2023) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17783 · Cited by 29
Self-citationLukkunaprasit, T., Tansawet, A., Boonmanunt, S. W., Sobhonslidsuk, A., McKay, G. J., Attia, J., & Thakkinstian, A. (2023) · Scientific Reports · doi:10.1038/s41598-023-33023-3 · Cited by 33
Screening for liver fibrosis: lessons from colorectal and lung cancer screening
Thiele, M. S., Kamath, P. S., Graupera, I., Castells, A., de Koning, H. J., Serra‐Burriel, M., Lammert, F., & Ginès, P. (2024) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-024-00907-2 · Cited by 30
“The AASLD MASLD guidelines recommend FIB-4, followed by TE or ELF as second-line in patients with an indeterminate FIB-4 score between 1.30 and 2.67, before specialist referral and confirmatory testing with magnetic resonance elastography or liver biopsy 62,63 .”
InfluentialHobeika, C., Ronot, M., Guiu, B., Ferraioli, G., Iijima, H., Tada, T., Lee, D. H., Kuroda, H., Lee, Y. H., Lee, J. M., et al. (2024) · Hepatology · doi:10.1097/hep.0000000000000895 · Cited by 28
“[51,57] Nevertheless, bio-marker combinations such as FAST and MAST, including CAP or MRI-PDFF, are promising.”
Sugimoto, K., Moriyasu, F., Burgio, M. D., Vilgrain, V., Jesper, D., Strobel, D. D., Blank, V., Karlas, T., Grant, E. G., Kelahan, L. C., et al. (2024) · Radiology · doi:10.1148/radiol.233377 · Cited by 28
Metabolic dysfunction-associated steatotic liver disease and the cardiovascular system
Manolis, A. A., Manolis, T. A., Vouliotis, A. I., & Manolis, A. S. (2025) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2025.01.001 · Cited by 33
Jackson, E., Dennis, A., Alkhouri, N., Samala, N. R., Vuppalanchi, R., Sanyal, A. J., Muthiah, M. D., Banerjee, R., & Banerjee, A. (2025) · Nature Medicine · doi:10.1038/s41591-025-03654-2 · Cited by 28
“Liver cT1 is associated with liver events in chronic liver disease 20 and major CV events in the general population 21 , as cited in gastroenterology 22 , endocrinology 23 , hepatology 24,25 and cardiology guidelines, which recommend quantitative MRI for CV risk stratification in MASLD 26 .”
Suresh, M. G., Mohamed, S., Geetha, H. S., Prabhu, S., Trivedi, N., Ng, Z. C., Mehta, P. D., Brar, A. S., Sohal, A., Goyal, M. K., et al. (2026) · World Journal of Diabetes · doi:10.4239/wjd.v17.i2.113149 · Cited by 30
“GLP-1 receptor agonists (GLP-1 RAs) improve glycemic control, reduce body weight, and lower hepatic fat content[80].”
Steatotic Liver Disease: New Nomenclature and Its Localization in the Russian Federation
Raikhelson, K. L., Maevskaya, M. V., Жаркова, М. С., Grechishnikova, V. R., Оковитый, С. В., Deeva, Т. A., Marchenko, N. V., Константиновна, П. М., & Ivashkin, V. T. (2024) · Russian Journal of Gastroenterology Hepatology Coloproctology · doi:10.22416/1382-4376-2024-961 · Cited by 28
Zhang, G. Y., & Brandman, D. (2025) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2024.6431 · Cited by 27
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“42,43 In the present study, we have explored whether a dual GPBAR1 and FXR agonist (BAR502) administered alone or in combination with atorvastatin effectively reverses the liver and cardiovascular phenotype promoted by exposure of wild-type or ApoE −/− mice to an HFD-F.”
BackgroundTranslational research on drug development and biomarker discovery for hepatocellular carcinoma
Chew, V., Chuang, C.-H., & Hsu, C. (2024) · Journal of Biomedical Science · doi:10.1186/s12929-024-01011-y · Cited by 29
“The non-viral subgroups included in HCC clinical trials encompass a heterogeneous population of patients with different etiologies or underlying liver diseases which are usually less stringently diagnosed on the basis of current clinical practice guidelines [109].”
BackgroundNon-invasive diagnosis of non-alcoholic fatty liver disease: Current status and future perspective
Wang, J., Jiang, S., Hu, A., Zhou, A.-W., Hu, T., Li, H., Fan, Y., & Lin, K. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e27325 · Cited by 28
“…MEFIB (the combination of MRE and FIB-4) and FAST for diagnosing significant fibrosis (F = 2) and found the former to be more effective than the latter and was incorporated into the 2023 AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease [24,68].”
BackgroundSantoro, S., Khalil, M., Abdallah, H., Farella, I., Noto, A., Dipalo, G. M., Villani, P., Bonfrate, L., Ciaula, A. D., & Portincasa, P. (2024) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2024.03.004 · Cited by 27
Zhang, S., Huo, Z., Borné, Y., Meng, G., Zhang, Q., Liu, L., Wu, H., Gu, Y., Sun, S., Wang, X., et al. (2024) · Preventive Medicine · doi:10.1016/j.ypmed.2024.107971 · Cited by 27
Mogna-Peláez, P., Riezu‐Boj, J. I., Milagro, F. I., Herrero, J. I., Elorz, M., Benito, A., Tobaruela-Resola, A. L., Tur, J. A., Martínez, J. A., Abete, I., et al. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.05.042 · Cited by 32
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Correlation between ZJU index and hepatic steatosis and liver fibrosis in American adults with NAFLD
Luo, S., Weng, X., Xu, J., & Lin, H. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1443811 · Cited by 27
Grinshpan, L. S., Haim, Y. E., Wajcman, D. I., Isakov, N. F., Nov, Y., Webb, M., Shibolet, O., Kariv, R., & Zelber‐Sagi, S. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000583 · Cited by 27
“[19,26] Dietary intake was first evaluated using a structured semi-quantitative food frequency questionnaire composed of 117/183 items (for baseline and follow-up surveys, respectively, the difference in the number of items stemming mostly from detailed meat preparation methods in the follow-up…”
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“7.”
Cardiovascular, kidney, and metabolic health: an actionable vision for heart failure prevention
Ostrominski, J. W., CHENG, A. Y. Y., Nelson, A. J., Neuen, B. L., Sattar, N. A., Tuttle, K. R., & Vaduganathan, M. (2025) · The Lancet · doi:10.1016/s0140-6736(25)01384-4 · Cited by 32
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“In the previously published studies, there was no information about the severity of liver fibrosis, which is one of the strongest predictors of all-cause mortality and adverse clinical outcomes in NAFLD [6, 8, 34].”
BackgroundMR Elastography: Practical Questions, From the AJR Special Series on Imaging of Fibrosis
Yin, M., & Ehman, R. L. (2023) · American Journal of Roentgenology · doi:10.2214/ajr.23.29437 · Cited by 26
Large-scale identification of undiagnosed hepatic steatosis using natural language processing
Schneider, C. V., Li, T., Zhang, D., Mezina, A. I., Rattan, P., Huang, H. Y. R., Creasy, K. T., Scorletti, E., Zandvakili, I., Vujković, M., et al. (2023) · EClinicalMedicine · doi:10.1016/j.eclinm.2023.102149 · Cited by 30
“31 Various approaches to identifying NAFLD patients using EHRs have been described and the majority of NLP cohorts have comprised a few hundred radiological/histologically con fi rmed NAFLD patients.”
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“The clear association between the two entities has been implemented in the latest guidelines of the American Association for the Study of Liver Diseases for the management of NAFLD [106].”
BackgroundKaylan, K. B., & Paul, S. (2024) · Current Diabetes Reports · doi:10.1007/s11892-024-01558-y · Cited by 27
“…Association of Clinical Endocrinology (AACE), American Association for the Study of Liver Diseases (AASLD), and American Gastroenterological Association (AGA) [6, 37– 39 ] as well as the European Association for the Study of the Liver (EASL) [40] and American Diabetes Association (ADA) [41].”
InfluentialQi, W., Cao, X., Chen, Y., Chen, H., Zhang, N., Liu, R., Wang, W., Liu, Q., Zheng, S., Li, S., et al. (2025) · Phytomedicine · doi:10.1016/j.phymed.2025.156559 · Cited by 27
Non-Invasive Tests as a Replacement for Liver Biopsy in the Assessment of MASLD
Frączek, J., Sowa, A., Agopsowicz, P., Migacz, M., Dylińska-Kala, K., & Holecki, M. T. (2025) · Medicina · doi:10.3390/medicina61040736 · Cited by 26
“…for these groups [16]. of at least two non-invasive tests (NITs), combining serum biomarkers and/or Current guidelines for the diagnosis, assessment of severity, and treatment of MASLD are widely known and available. mention the possibility of using a serum biomarker such as ELF [14,15] (Figure 2).”
InfluentialWu, S., Anand, N., Guo, Z., Li, M., Figueroa, M. S., Jung, L., Kelly, S., & Franses, J. W. (2025) · Cancers · doi:10.3390/cancers17111860 · Cited by 27
“By 2030, MAFLD/MASH is projected to become the leading cause of HCC in the United States and Europe [10,11].”
Nonalcoholic Fatty Liver Disease in Diabetes: A Call to Action
Cusi, K. J. (2024) · Diabetes Spectrum · doi:10.2337/dsi23-0015 · Cited by 26
Exercise Is Medicine for Nonalcoholic Fatty Liver Disease: Exploration of Putative Mechanisms
Heinle, J. W., DiJoseph, K., Sabag, A., Oh, S., Kimball, S. R., Keating, S., & Stine, J. G. (2023) · Nutrients · doi:10.3390/nu15112452 · Cited by 26
Metadata
- Authors
- Rinella, M. E., Neuschwander-Tetri, B. A., Siddiqui, M. S., Abdelmalek, M. F., Caldwell, S., Barb, D., Kleiner, D. E., & Loomba, R.
- Affiliations
- University of Chicago (US)
- Saint Louis University School of Medicine, Saint Louis, Missouri, USA
- Virginia Commonwealth University (US)
- Mayo Clinic (US)
- University of Virginia (US)
- University of Florida Health (US)
- National Institutes of Health (US)
- University of California San Diego (US)
- Corresponding author
- Rinella, Mary E.
- ORCID
- Venue
- Hepatology
- Published
- 2023-03-17
- Volume
- 77
- Issue
- 5
- Pages
- 1797-1835
- ISSN
- 0270-9139 (ISSN-L)
- PMC
- PMC10735173
- OpenAlex
- W4318923555
- Cited by
- 2,667
- References
- 502
- Citations by year
- 2026: 849 · 2025: 845 · 2024: 691 · 2023: 281
- FWCI
- 532.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- American Association for the Study of Liver Diseases
- NGM Biopharmaceuticals
- Novo Nordisk
- National Institutes of Health
- Allergan
- National Cancer Institute (ZICBC010685)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, non-invasive risk stratification, non-invasive tests, fibrosis staging, liver cirrhosis
- MeSH terms
- Humans, Liver, Liver Cirrhosis, Disease Progression, Non-alcoholic Fatty Liver Disease
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