The DOI matches its Crossref record; 499 of the 502 references it cites were found in a registry or an index.
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
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Current guidelines recommend weight loss through dietary modifications, increased physical activity, or both combined in MASLD patients [7, 11, 12].”
The cited source says what the claim attributes to it.
In the citing paper
“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]
In the citing paper
“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]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes
Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., Mattheus, M., Devins, T., Johansen, O. E., Woerle, H. J., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1504720 · Cited by 12,315
Design and validation of a histological scoring system for nonalcoholic fatty liver disease†
Kleiner, D. E., Brunt, E. M., Van Natta, M., Behling, C., Contos, M. J., Cummings, O. W., Ferrell, L. D., Liu, Y., Torbenson, M. S., Unalp‐Arida, A., et al. (2005) · Hepatology · doi:10.1002/hep.20701 · Cited by 10,791
Self-citationYounossi, Z. M., Koenig, A. B., Abdelatif, D., Fazel, Y., Henry, L., & Wymer, M. (2016) · Hepatology · doi:10.1002/hep.28431 · Cited by 10,781
Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., Harrison, S. A., Brunt, E. M., & Sanyal, A. J. (2018) · Hepatology · doi:10.1002/hep.29367 · Cited by 7,239
Self-citationSemaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., Lingvay, I., Rosenstock, J., Seufert, J., Warren, M. L., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1607141 · Cited by 6,900
Once-Weekly Semaglutide in Adults with Overweight or Obesity
Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2032183 · Cited by 5,205
Sterling, R. K., Lissen, E., Clumeck, N., Sola, R., Correa, M. C., Montaner, J., S. Sulkowski, M., Torriani, F. J., Dieterich, D. T., Thomas, D. L., et al. (2006) · Hepatology · doi:10.1002/hep.21178 · Cited by 5,021
Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects
Sjöström, L., Narbro, K., Sjöström, C. D., Karason, K., Larsson, B., Wedel, H., Lystig, T., Sullivan, M., Bouchard, C., Carlsson, B., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa066254 · Cited by 4,668
Marrero, J. A., Kulik, L., Sirlin, C. B., Zhu, A. X., Finn, R. S., Abecassis, M. M., Roberts, L. R., & Heimbach, J. K. (2018) · Hepatology · doi:10.1002/hep.29913 · Cited by 4,597
Mechanisms of NAFLD development and therapeutic strategies
Friedman, S. L., Neuschwander-Tetri, B. A., Rinella, M., & Sanyal, A. J. (2018) · Nature Medicine · doi:10.1038/s41591-018-0104-9 · Cited by 4,354
Self-citation
Cited by
Sorted by citations
Items 401–500 of 1,002
Potential Therapeutic Strategies in the Treatment of Metabolic-Associated Fatty Liver Disease
Bołdys, A., Bułdak, Ł., Maligłówka, M., Surma, S., & Okopień, B. (2023) · Medicina · doi:10.3390/medicina59101789 · Cited by 23
“In summary, medications affecting carbohydrate metabolism are well-established within the AASLD guidelines [10].”
BackgroundInfluentialAdvances in Noninvasive Biomarkers for Nonalcoholic Fatty Liver Disease
Gîlcă-Blanariu, G.-E., Budur, D. S., Mitrică, D., Gologan, E., Timofte, O., Bălan, G. G., OLTEANU, V.-A., & Ștefănescu, G. (2023) · Metabolites · doi:10.3390/metabo13111115 · Cited by 21
“Medical comorbidities, such as obesity, diabetes, discovering features of advanced liver disease such as a firm liver or dyslipidemia, and abnormalities in the liver biochemistry like elevated aminotransferases, all represent arguments for screening for NAFLD [11].”
BackgroundWang, W., Wang, Y., Song, D., Zhou, Y., Luo, R., Ying, S.-Q., Yang, L., Sun, W., Cai, J., Wang, X., et al. (2024) · Liver International · doi:10.1111/liv.15846 · Cited by 20
“3 The development of quantitative radiomics analysis helps extract high-dimensional image features for MVI classifications.”
BackgroundEmerging therapies for MASLD and their impact on plasma lipids
Nguyen, M., Asgharpour, A., Dixon, D. L., Sanyal, A. J., & Mehta, A. (2024) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2024.100638 · Cited by 20
“AASLD guidelines suggest pioglita-zone as a potential therapy for patients with biopsy-proven MASH who concurrently have diabetes, however, weight gain is a limiting side effect [10].”
BackgroundInfluentialNjei, B. M., Ameyaw, P. A., Al‐Ajlouni, Y. A., Njei, L., & Boateng, S. (2024) · Cureus · doi:10.7759/cureus.71451 · Cited by 24
“However, sustaining weight loss poses challenges, necessitating a multidisciplinary approach involving nutrition services, psychological support, and social systems [94,101,102].”
InfluentialFerraioli, G., Roccarina, D., & Barr, R. G. (2024) · Radiology · doi:10.1148/radiol.240162 · Cited by 19
Perakakis, N., Bornstein, S. R., Birkenfeld, A. L., Linkermann, A., Demir, M., Anker, S. D., Filippatos, G. S., Pitt, B., Rossing, P. R., Ruilope, L. M., et al. (2023) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15305 · Cited by 20
“40,41 For the FIB-4 cut-offs, two analyses were performed.”
BackgroundMethodInfluentialSood, V., Alam, S., Nagral, A. S., Srivastava, A., Deshmukh, A., Bavdekar, A., Acharyya, B. C., Geetha, S., Gupte, G. L., Bhatia, I., et al. (2024) · Indian Pediatrics · doi:10.1007/s13312-024-3290-1 · Cited by 19
Cannella, R., Agnello, F., Porrello, G., Spinello, A., Infantino, G., Pennisi, G., Cabibi, D., Petta, S., & Bartolotta, T. V. (2024) · European Radiology · doi:10.1007/s00330-024-11076-w · Cited by 18
Luthra, R., & Sheth, A. (2024) · Advances in Therapy · doi:10.1007/s12325-024-03085-4 · Cited by 21
Non-invasive tests for fibrotic MASH for reducing screen failure in therapeutic trials
Fichez, J., Mouillot, T., Vonghia, L., Costentin, C. E., Moreau, C., Roux, M., Delamarre, A., Francque, S., Zheng, M., & Boursier, J. (2025) · JHEP Reports · doi:10.1016/j.jhepr.2025.101351 · Cited by 18
Adinolfi, L. E., Marrone, A., Rinaldi, L., Nevola, R., Izzi, A., & Sasso, F. C. (2025) · Exploration of Medicine · doi:10.37349/emed.2025.1001281 · Cited by 18
Yakubu, I., Spengler, J., Taylor, P. D., LaPorte, M., Brown, A., Sterling, S., Agegnehu, B., Iaria, A., Marks, R., Sprague, T., et al. (2025) · Transplantation · doi:10.1097/tp.0000000000005361 · Cited by 19
Self-citationAlkhouri, N., Yip, T. C., Castéra, L., Takawy, M., Adams, L. A., Verma, N., Arab, J. P., Jafri, S., Zhong, B., Dubourg, J., et al. (2025) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003432 · Cited by 21
“Although major gastroenterological societies, including AGA (8), AASLD (9), and European Association for the Study of Liver Diseases (10,18) advocate using the FIB-4 as the initial screening test, our study shows that a rule-out cuto ff of 1.3 has suboptimal sensitivity of 63% – 68% for the…”
InfluentialSelf-citationVidal-Trécan, T., Julla, J., Khoury, T. E., Venteclef, N., Riveline, J., Paradis, V., Valla, D. C., Gautier, J., & Castéra, L. (2025) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2025.02.018 · Cited by 20
Díaz, L. A., Tavaglione, F., Mittal, N., Bettencourt, R., Amangurbanova, M., Johnson, A., Aguado, D. M., Tincopa, M. A., Loomba, R. K., Khan-Riches, A., et al. (2025) · Hepatology Communications · doi:10.1097/hc9.0000000000000718 · Cited by 19
“[11,12,14]”
Self-citationHepatocellular Carcinoma Surveillance and Survival in a Contemporary Asia-Pacific Cohort
Lim, R. Y., Koh, B., Ng, C. H., Kulkarni, A. V., Liu, K., Wijarnpreecha, K., Kim, B. K., Muthiah, M. D., Lee, S. W., Zheng, M., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.20294 · Cited by 21
Gao, Y., Li, C., Chang, W., Du, B., Ye, X., Yeo, Y. H., Xia, Y., Guo, H., Zhang, X., Liu, W., et al. (2026) · Nature Communications · doi:10.1038/s41467-026-68414-3 · Cited by 22
“…to transform the current standard of care of steatosis patients, we embed MAOSS into the American Association for the Study of Liver Diseases (AASLD) clinical practice guidance 41 for screening and referring patients established with steatosis who may be at risk of progression to more serious CLDs.”
Gupta, U., Ruli, T. M., Buttar, D., Shoreibah, M., & Gray, M. E. (2023) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2023.11.007 · Cited by 19
Suárez, M., Gil-Rojas, S., Martínez-Blanco, P., Torres, A., Ramón, A., Blasco-Segura, P., Torralba, M., & Mateo, J. (2024) · Cancers · doi:10.3390/cancers16061114 · Cited by 18
“It is defined as the presence of macrovesicular steatosis in ≥ 5% of hepatocytes in the absence of other diseases, such as hepatitis B or C, or excessive alcohol consumption (20 g/day in women and 30 g/day in men) [3].”
BackgroundHaque, L., Zuluaga, P., Muga, R., & Fuster, D. (2024) · Addiction Science & Clinical Practice · doi:10.1186/s13722-024-00448-8 · Cited by 18
“An optimal nutritional assessment with recommendations that support weight loss if indicated can reduce the risk of additional liver injury from metabolic dysfunction-asso-ciated steatohepatitis in patients with unhealthy alcohol use who are obese or overweight [35–37].”
BackgroundLiu, S., Chen, X., Jiang, X., Yin, X., Fekadu, G., Liu, C., He, Y., Chen, H., Ni, W., Wang, R., et al. (2024) · Med · doi:10.1016/j.medj.2024.03.003 · Cited by 20
Yasin, A., Nguyen, M., Sidhu, A., Majety, P., Spitz, J. A., Asgharpour, A., Siddiqui, M. S., Sperling, L. S., Quyyumi, A. A., & Mehta, A. (2024) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2024.111650 · Cited by 19
Self-citationCeliac Disease, Gluten-Free Diet and Metabolic Dysfunction-Associated Steatotic Liver Disease
Cazac, G.-D., Mihai, B. M., Ștefănescu, G., Gîlcă-Blanariu, G.-E., Mihai, C., Grigorescu, E.-D., Onofriescu, A., & Lăcătușu, C.-M. (2024) · Nutrients · doi:10.3390/nu16132008 · Cited by 18
“…including referral to bariatric surgery, trained psychology specialists, and additional cardiology, lipid, or metabolic support, should be implemented on an individualized basis [14,38]. additional cardiology, lipid, or metabolic support, should be implemented on an individualized basis [14,38].”
BackgroundInfluentialJamalinia, M., & Lonardo, A. (2024) · Metabolism and Target Organ Damage · doi:10.20517/mtod.2024.34 · Cited by 18
Weinstein, G., Schonmann, Y., Yeshua, H., & Zelber‐Sagi, S. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.14033 · Cited by 22
“15,16 Compared to liver biopsy, FIB-4 shows a summary area under the receiver operating characteristic (AUROC) of 84% for diagnosing advanced fibrosis.”
BackgroundAfonso, M. B., David, J. C., Alves, M. I., Santos, A. A., Campino, G., Ratziu, V., Gautheron, J., & Rodrigues, C. M. P. (2024) · Metabolism · doi:10.1016/j.metabol.2024.155975 · Cited by 19
Liu, C., Seto, W., & Yu, M. (2024) · Hepatology International · doi:10.1007/s12072-024-10699-x · Cited by 18
“Current international guidelines do not recommend a healthy margin for drinking in MAFLD; the Asia–Pacific guidelines recommend that all MAFLD patients should refrain from alcohol [96], while the US guidelines recommend alcohol abstinence for patients with clinically significant ≥ F2 fibrosis [97].”
Xu, M., Zhan, Y., Gao, G., Zhu, L., Wu, T., & Xin, G. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1446694 · Cited by 18
Gad, A. I., Ibrahim, N. F., Almadani, N. A., Mahfouz, R., Nofal, H. A. E., Elrafey, D. S., Ali, H. T., Elhawary, A. T., & Sadek, A. M. E. M. (2024) · Diseases · doi:10.3390/diseases12080186 · Cited by 20
Tincopa, M. A., Díaz, L. A., Huang, D. Q., Arab, J. P., Arrese, M. A., Gadano, A., de Oliveira, C. P. M. S., Bettencourt, R., Madamba, E. V., Kim, S., et al. (2024) · Hepatology · doi:10.1097/hep.0000000000001121 · Cited by 20
“[16,17] The recent approval of resmetirom for the treatment of MASH increases the urgency of ensuring cut-points for NITs are effective for the identification of patients across racial/ethnic groups who would most benefit from therapy.”
Self-citationManagement strategies for metabolic dysfunction–associated steatotic liver disease (MASLD)
Alkhouri, N., & Noureddin, M. (2024) · The American Journal of Managed Care · doi:10.37765/ajmc.2024.89635 · Cited by 23
Czapla, B., Dalvi, A., Hu, J., Moran, I. J., Wijarnpreecha, K., & Chen, V. L. (2025) · Scientific Reports · doi:10.1038/s41598-025-93082-6 · Cited by 18
Liver fibrosis, NT-ProBNP and mortality in patients with MASLD: A population-based cohort study
Ciardullo, S., Cannistraci, R., Muraca, E., Zerbini, F., & Perseghin, G. (2024) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2023.11.011 · Cited by 20
Kubina, M., Prasitsumrit, V., Tan, J., Quek, J. W. E., Peddu, D. K., Mishra, A. K., Danpanichkul, P., Mann, J. P., Trépo, E., Buch, S., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70256 · Cited by 17
“Notably, this sub hazard ratio for MALO risk is similar to that of type 2 diabetes [72, 73], which is a well-recognised risk factor described in clinical practice guidelines [74, 75].”
Corey, K. E., Nakrour, N., Bethea, E. D., Shay, J. E. S., Andersson, K. L., Bhan, I., Friedman, L. S., Kambadakone, A. R., Dichtel, L. E., Chung, R. T., et al. (2025) · Liver International · doi:10.1111/liv.70280 · Cited by 18
Chen, L., Horn, P., & Tacke, F. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70545 · Cited by 20
Tapper, E. B., Bonafede, M., Fishman, J., Dodge, S., Miller, K., Zeng, N., Lewandowski, D., & Bogdanov, A. (2023) · Journal of Medical Economics · doi:10.1080/13696998.2023.2184967 · Cited by 17
Hunt, C. M., Lee, T. H., Morgan, T. R. M., & Campbell, S. M. (2023) · Gastroenterology · doi:10.1053/j.gastro.2023.04.009 · Cited by 17
Young Adult Physical Activity Trajectories and Midlife Nonalcoholic Fatty Liver Disease
de Brito, J. N., McDonough, D. J., Mathew, M., VanWagner, L. B., Schreiner, P. J., Gabriel, K. P., Jacobs, D. R., Terry, J. G., Carr, J. J., & Pereira, M. A. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.38952 · Cited by 17
What Is in a Name: from NAFLD to MAFLD and MASLD—Unraveling the Complexities and Implications
Ramírez-Mejía, M. M., & Méndez‐Sánchez, N. (2023) · Current Hepatology Reports · doi:10.1007/s11901-023-00620-9 · Cited by 17
Roles of innate lymphoid cells in metabolic and alcohol-associated liver diseases
Bourinet, M., Anty, R., Gual, P., & Luci, C. (2023) · JHEP Reports · doi:10.1016/j.jhepr.2023.100962 · Cited by 20
Lee, J., Park, J., & Ahn, S. B. (2023) · Nutrients · doi:10.3390/nu16010140 · Cited by 17
“…steatotic liver disease (MASLD), a new consensus-driven proposed nomenclature replacing “nonalcoholic fatty liver disease (NAFLD)” [1], affects a substantial portion of the global population and poses a growing public health concern because of its potential to progress to advanced…”
BackgroundMitochondrial targets in hyperammonemia: Addressing urea cycle function to improve drug therapies
Moedas, M. F., Simões, R. J., & Silva, M. F. B. (2024) · Biochemical Pharmacology · doi:10.1016/j.bcp.2024.116034 · Cited by 18
Hormone-based pharmacotherapy for metabolic dysfunction-associated fatty liver disease
Chui, Z. S. W., Xue, Y., & Xu, A. (2024) · Medical Review · doi:10.1515/mr-2024-0007 · Cited by 21
Hypogonadism and nonalcoholic fatty liver disease
Papadimitriou, K., Mousiolis, A. C., Mintziori, G., Tarenidou, C., Pοlyzos, S. A., & Goulis, D. G. (2024) · Endocrine · doi:10.1007/s12020-024-03878-1 · Cited by 18
“Besides lifestyle interventions or bariatric surgery, some medications (Table 1) have shown bene fi ts for NAFLD in clinical trials, but they are not speci fi cally approved for its treatment [133].”
InfluentialXiao, S., Liu, Y., Fu, X., Chen, T., & Xie, W. (2024) · The American Journal of Medicine · doi:10.1016/j.amjmed.2024.06.031 · Cited by 17
Arold, D., Bornstein, S. R., Perakakis, N., Ehrlich, S., & Bernardoni, F. (2024) · Metabolism · doi:10.1016/j.metabol.2024.155983 · Cited by 18
Faienza, M. F., Farella, I., Khalil, M., & Portincasa, P. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25189924 · Cited by 17
“The nomenclature aspect and, as mentioned earlier, an almost complete overlap of populations exists between MASLD and NAFLD in adults [21–23], but this aspect is still poorly investigated at pediatric age [14].”
BackgroundMethodInfluentialKarahan, T. Ö., Kenger, E. B., & Yilmaz, Y. N. (2025) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70033 · Cited by 18
Mathur, A., Ozkaya, E., Rosberger, S., Sigel, K. M., Doucette, J. T., Bansal, M. B., & Taouli, B. A. (2025) · European Radiology · doi:10.1007/s00330-025-11533-0 · Cited by 17
Bołdys, A., & Bułdak, Ł. (2024) · World Journal of Gastroenterology · doi:10.3748/wjg.v30.i18.2387 · Cited by 17
Prevalence and determinants of liver disease in relatives of Italian patients with advanced MASLD
Pelusi, S., Ronzoni, L., Rondena, J., Rosso, C., Pennisi, G., Dongiovanni, P., Margarita, S., Carpani, R., Soardo, G., Prati, D., et al. (2024) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2023.12.033 · Cited by 16
Condon, S., Hu, H., Kong, M., Cave, M. C., & McClain, C. J. (2024) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2024.01.022 · Cited by 16
Panagiotopoulos, N., Wolfson, T. J., Harris, D. T., Batakis, D., Agni, R. M., Ceriani, L., Covarrubias, Y., Hamilton, G., Middleton, M. S., Martins, V. F., et al. (2025) · Hepatology · doi:10.1097/hep.0000000000001318 · Cited by 16
Obesity and its management in primary care setting
Ibrahim, M. A., Ba-Essa, E. M., Alvarez, J. A., Baker, J. C., Bruni, V., Cahn, A., Ceriello, A., Cosentino, F., Davies, M. J., Domenico, F. D., et al. (2025) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2025.109045 · Cited by 21
van Kleef, L. A., Strandberg, R., Pustjens, J., Hammar, N., Janssen, H. L. A., Hagström, H., & Brouwer, W. P. (2025) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2025.06.036 · Cited by 17
Nanomedicines in the Treatment of Liver Fibrosis: A Review
Du, X., Niu, R., Liu, X., Wu, F., Yang, X., Ma, X., Zhang, J., Zhou, H.-H., Shao, L., & Wang, S. (2025) · International Journal of Nanomedicine · doi:10.2147/ijn.s524078 · Cited by 20
“29 Moreover, targeted symptomatic management of portal hypertension, ascites, and hepatic encephalopathy-through administration of nonselective β-adrenergic blockers, judicious diuretic regimens, and use of laxatives -is pivotal for improving patient quality of life and forestalling cirrhotic…”
M et ALD : Diagnosis and Prognosis With Non‐Invasive Tests
Torp, N., Israelsen, M. E., Johansen, S., Semmler, G., Hansen, C. D., Bech, K., Andersen, M. L., Thorhauge, K. H., Andersen, P., Schnefeld, H. L., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70281 · Cited by 16
“Most referral pathways suggest the incorporation of NITs as part of a two-or three-tiered strategy for detecting advanced hepatic fibrosis in at-risk populations [6].”
Huber, Y., Hofmann, L. J., Prochaska, J. H., Koeck, T., Chalabi, J., Pfeiffer, N., Beutel, M. E., Strauch, K., Lackner, K. J., Tuescher, O., et al. (2025) · European Journal of Heart Failure · doi:10.1002/ejhf.70053 · Cited by 16
Endocrine Disorders and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Narrative Review
Betlejewska, J., Hubska, J., Roszkowska, Z., Maciejczyk, A., Bachurska, D., Domański, J., Miarka, M., Raszeja‐Wyszomirska, J., Bobrowicz, M., & Ambroziak, U. (2025) · Biomedicines · doi:10.3390/biomedicines13102500 · Cited by 20
“…the Study of Liver Disease recommends the use of liver elastography with the FibroScan technique as a screening tool for the detection of hepatic steatosis in individuals with risk factors for MASLD, including overweight, obesity, elevated serum lipid levels, T2DM and arterial hypertension [172].”
Palumbo, P., Betto, G. D., Menozzi, R., Koek, G. H., & Buzzetti, E. (2025) · Metabolism · doi:10.1016/j.metabol.2025.156425 · Cited by 19
Tamilwanan, S., Aziz, Z., Rong, L. Y., Bitar, A. N., Zarzour, R. A., & Alshehade, S. A. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-04358-0 · Cited by 21
“Evidence assessment incorporated established clinical decision thresholds from regulatory guidance and professional society recommendations [24].”
The Gut-Liver Axis: Molecular Mechanisms and Therapeutic Targeting in Liver Disease
Ma, L., Wang, H., Jin, Q., Sun, Z., Yu, S., & Zhang, Y. (2025) · International Journal of General Medicine · doi:10.2147/ijgm.s551494 · Cited by 19
Kaplan, L. M., Startseva, E., le Roux, C. W., Wharton, S., Bozkurt, B., Mazo, D. F. D. C., von Schlippenbach, J., Maldonado, S. G., Hussain, S. A., Neff, G. W., et al. (2026) · Nature Medicine · doi:10.1038/s41591-026-04479-3 · Cited by 19
“However, the ELF score, which is a marker of extracellular matrix turnover and fibrogenesis, at baseline also reflected mild-to-moderate fibrosis (advanced fibrosis is likely at ≥9.8 and unlikely at 7.7) 2,9 and showed an absolute reduction of 0.34 after 48 weeks of treatment with survodutide.”
InfluentialNutritional and Lifestyle Therapy for NAFLD in People with HIV
Cinque, F., Cespiati, A., Lombardi, R., Guaraldi, G., & Sebastiani, G. (2023) · Nutrients · doi:10.3390/nu15081990 · Cited by 19
Liu, R., Qian, M., & Cui, Y. (2023) · Metabolism · doi:10.1016/j.metabol.2023.155665 · Cited by 17
Zhao, D., Yan, H., Han, Y., Zhang, W.-M., Zhao, Y., & Liao, H.-Y. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1142177 · Cited by 16
Gruzdev, S., Podoprigora, I. V., & Gizinger, O. A. (2024) · Archives of Microbiology · doi:10.1007/s00203-023-03752-0 · Cited by 17
Serbis, A., Pοlyzos, S. A., Paschou, S. Α., Siomou, E. C., & Kiortsis, D. N. (2024) · Endocrine · doi:10.1007/s12020-024-03783-7 · Cited by 16
“[20], but lower in children ( ≥ 75”
BackgroundÅström, H., Shang, Y., Hagström, H., & Wester, A. (2024) · Liver International · doi:10.1111/liv.16019 · Cited by 16
“21,22 Thus, it is possible that persons with depression have a higher innate risk of MALO.”
Albhaisi, S. A. M., Tondt, J., Cyrus, J. W. W., Chinchilli, V. M., Conroy, D. E., & Stine, J. G. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000499 · Cited by 16
“[3] However, achieving and maintaining clinically significant weight loss is challenging, and many patients are unsuccessful.”
Yeh, M., Huang, J., Dai, C., Huang, C., Yu, M., & Chuang, W. (2024) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2024.2388790 · Cited by 16
“Other modalities such as MR imaging or CT imaging could be alternatives [49,50].”
InfluentialJin, X., Xu, J., & Weng, X. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1428593 · Cited by 16
Baek, J. W., Yang, Y. S., Jung, K. J., Kimm, H., Kim, S. Y., Lee, S., & Jee, S. H. (2024) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2024.09.001 · Cited by 16
Non-invasive imaging biomarkers in chronic liver disease
Maino, C., Vernuccio, F., Cannella, R., Cristoferi, L., Franco, P. N., Carbone, M., Cortese, F., Faletti, R., Bernardi, E. D., Inchingolo, R., et al. (2024) · European Journal of Radiology · doi:10.1016/j.ejrad.2024.111749 · Cited by 16
Dabbah, S., Mishani, I., Davidov, Y., & Ben‐Ari, Z. (2024) · Digestion · doi:10.1159/000542241 · Cited by 16
Nishimura, T., Tada, T., Akita, T., Kondo, R., Suzuki, Y., Imajo, K., Kokubu, S., Abe, T., Kuroda, H., Hirooka, M., et al. (2025) · Journal of Gastroenterology · doi:10.1007/s00535-025-02224-0 · Cited by 17
“The American Association for The Study of Liver Disease (AASLD) Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease states that CAP does not accurately quantify or monitor changes in liver fat [30].”
Two-Year Mediterranean Diet Intervention Improves Hepatic Health in MASLD Patients
Monserrat-Mesquida, M., Bouzas, C., García, S., Mateos, D., Casares, M., Ugarriza, L., Gómez, C., Sureda, A., & Tur, J. A. (2025) · Foods · doi:10.3390/foods14101736 · Cited by 19
“Lower CK-18 levels suggest improved liver health, such as reduced hepatocyte apoptosis and necrosis, reflecting a potential improvement in liver function [49].”
Wu, Y., Dong, P., Wu, Q., Zhang, Y., Xu, G., Pan, C., & Tong, H. (2025) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.3606 · Cited by 18
Qiu, T. H., Zhu, X., Wu, J., Hong, W., Hu, W., & Fang, T. (2025) · Scientific Reports · doi:10.1038/s41598-025-92282-4 · Cited by 15
“The risk of hepatic complications and death increases mainly with increasing liver fibrosis 4,5 ; therefore, slowing or reversing fibrosis is important.”
Wong, V. W., Neff, G. W., Bisceglie, A. M. D., Bai, R., Cheng, J., Meng, Y., Liberman, A., Liu, L., & Gunn, N. (2025) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2025.0145 · Cited by 15
Kim, Y., Rydqvist, P., Ramezani, T., Haas, J. S., Bantel, H., Buggisch, P., Geier, A., Hofmann, W. P., Mauss, S., Roeb, E., et al. (2025) · Liver International · doi:10.1111/liv.70225 · Cited by 14
“In the absence of an approved drug specifically indicated for MASH, this is largely in line with relevant treatment guidelines [2, 5, 26].”
Sex Differences in MASLD After Age 50: Presentation, Diagnosis, and Clinical Implications
Milani, I., Parrotta, M. E., Colangeli, L., Chinucci, M., Palleschi, S., Rossi, B., Sbraccia, P., Mantovani, A., Leonetti, F., Guglielmi, V., et al. (2025) · Biomedicines · doi:10.3390/biomedicines13092292 · Cited by 15
“On the other hand, the AASLD has reported limited accuracy of the CAP in quantifying hepatic steatosis [84], with measurement failures more common in female sex, probably due to differences in fat distribution [85].”
Wen, W., Liu, Z., Tan, W., Tan, Y., Li, W., Wan, J., Hu, H., Jiang, Z., Tang, X., Yang, J., et al. (2026) · npj Digital Medicine · doi:10.1038/s41746-026-02352-8 · Cited by 18
“When integrated with imaging assistance, these markers could facilitate the early strati fi cation of high-risk MASH populations and consequently reduce the current reliance on invasive liver biopsies 53 .”
DiStefano, J. K. (2023) · Nutrients · doi:10.3390/nu15122670 · Cited by 15
“Specifically, reducing caloric intake, limiting consumption of simple sugars and saturated fats, and increasing physical activity levels to promote weight loss and improve metabolic parameters are recommended as the first-line therapy for NAFLD patients [18,19].”
BackgroundSuárez, M., Martínez, R., Torres, A., Torres, B., & Mateo, J. (2023) · Digestive Diseases and Sciences · doi:10.1007/s10620-023-08031-y · Cited by 16
“There are also frequent updates of the clinical guidelines, such as the recently published by the American Association for the Study of Liver Diseases (AASDL) [5], and guidelines for patients to provide them with information on the disease [38].”
BackgroundNutrition in Liver Disease – A Review
Hepburn, C., & Roenn, N. V. (2023) · Current Gastroenterology Reports · doi:10.1007/s11894-023-00887-4 · Cited by 15
Martínez‐Domínguez, S. J., García, S. G., Gargallo-Puyuelo, C. J., Llera, B. G., Refaie, E., Callau, P., Mendi, C., Baptista, P. M., Ainsa, M. H., Arroyo, M., et al. (2023) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2023.10.019 · Cited by 15
Optimal ALT threshold for the automated diagnosis of MASLD: A population-based study using iLFT
Lee, J., Byrne, C. J., Brennan, P., MacPherson, I. S., Dow, E., & Dillon, J. F. (2024) · Annals of Hepatology · doi:10.1016/j.aohep.2023.101280 · Cited by 15
Noninvasive assessment of liver fibrosis and portal hypertension
Duarte‐Rojo, A., Patel, K., & Rockey, D. C. (2024) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000001019 · Cited by 16
“Simple indirect markers such as FIB-4 and APRI (Table 1) are now routinely used to establish pretreatment disease severity in patients with viral hepatitis prior to antiviral therapy and we recommend these as first metabolic-dysfunc-tion associated steatotic liver disease (MASLD) [9,10].”
MethodThe biochemical pattern defines MASLD phenotypes linked to distinct histology and prognosis
Ampuero, J., Aller, R., Gallego‐Durán, R., Crespo, J., Calleja, J. L., García‐Monzón, C., Gómez‐Camarero, J., Caballería, J., Iacono, O. L., Ibáñez, L., et al. (2024) · Journal of Gastroenterology · doi:10.1007/s00535-024-02098-8 · Cited by 17
Guo, Y., Gao, Z., LaGory, E. L., Wilson, K. L., Gupte, J., Gong, Y., Rardin, M. J., Liu, T., Nguyen, T. T., Long, J., et al. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000419 · Cited by 15
“[ 1 ] Therefore, there is an unmet medical need to identify novel therapeutic targets and treatments.”
BackgroundKalopitas, G., Arvanitakis, K., Tsachouridou, Ο., Malandris, K., Koufakis, T., Metallidis, S., & Germanidis, G. S. (2024) · Life · doi:10.3390/life14060742 · Cited by 15
Savino, A., Loglio, A., Neri, F., Camagni, S., PASULO, L., Lucà, M. G., Trevisan, R., FAGIUOLI, S., & Viganò, M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13133871 · Cited by 15
“It is associated with high mortality, mainly due to CV disease and metabolic complications, in addition to non-hepatic malignancies and liver failure, which is strongly linked to the fibrosis stage [1,22,23].”
BackgroundSteatotic liver disease and HIV: an agenda for 2030
Pericàs, J. M., Arora, A. K., Riebensahm, C., Jiménez-Masip, A., Mena, A. R., White, T. M., Dedes, N., Guaraldi, G., Berzigotti, A., Wandeler, G., et al. (2024) · The Lancet HIV · doi:10.1016/s2352-3018(24)00097-3 · Cited by 15
Khanmohammadi, S., Habibzadeh, A., Kamrul-Hasan, A. B. M., Schuermans, A., & Kuchay, M. S. (2024) · Diabetic Medicine · doi:10.1111/dme.15437 · Cited by 17
“24 The current systematic review demonstrated that TZDs significantly reduced the risk of NAFLD and cirrhosis and had a more substantial effect on liver-related outcomes compared to sulfonylureas and DPP-4I.”
Seko, Y., Yamaguchi, K., Shima, T., Iwaki, M., Takahashi, H., Kawanaka, M., Tanaka, S., Mitsumoto, Y., Yoneda, M., Nakajima, A., et al. (2024) · Liver International · doi:10.1111/liv.16124 · Cited by 15
“Liver fibrosis is a risk factor for LRE occurrence, and guidelines recommend the use of non-invasive tests (NITs), such as the fibrosis-4 (FIB-4) index and the enhanced liver fibrosis (ELF) test, as criteria for referral to hepatologists [4, 5].”
Vitamin E for people with non-alcoholic fatty liver disease
Wen, H.-Z., Deng, H., Yang, L., Li, L., Lin, J., Zheng, P., Bjelaković, M., & Ji, G. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015033.pub2 · Cited by 15
Huang, J., Chang, T., Yeh, M., Shen, F., Tai, C., Chen, J., Huang, Y., Hsu, C., Cheng, P., Lin, C., et al. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000571 · Cited by 15
“[60] position statements 8 – 10 in Table 1.”
Background
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
