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Last Updated: 11/22/2013  

Nonalcoholic Fatty Liver Disease

NAFLD may progress to NASH. In the adult population of the U.S., the estimated prevalence of NAFLD is 30%, and that of NASH is 3% to 5%. It is estimated that 4% of patients with steatosis alone and 26% of patients with NASH progress to cirrhosis over a 10-year period. Obesity and diabetes mellitus type 2 are the major risk factors for NAFLD and NASH. In the presence of morbid obesity, the prevalence of NAFLD was greater than 90%, and that of NASH was greater than 30%.

Diagnosis
  • Most patients with NAFLD are asymptomatic and some present with nonspecific symptoms such as fatigue.

  • The most common finding is elevated transaminases, with or without hepatomegaly.

  • Laboratory evaluation should include LFTs, fasting glucose, fasting lipid profile, and lab tests associated with advanced liver disease such as prothrombin time, platelet count, and albumin.

  • Exclude alternative clinical conditions associated with abnormal LFT results.

  • Consider liver biopsy for definitive diagnosis in selected patients who are at increased risk for fibrosis or NASH.

Therapy
  • Counsel overweight and morbidly obese patients about diet, exercise, and weight loss surgery, although the evidence supporting these as treatments for NAFLD has been inconclusive.

  • Discuss with patients the limited effectiveness of most drug therapies for NAFLD, except possibly insulin sensitizers in some patients with diabetes.

DOI: 10.7326/d069
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Shweta Nagendra, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Claudia Zein, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Yngve Falck-Ytter, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Amanda Christini, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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