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JAMA Clinical Guidelines Synopsis
December 18, 2018

Diagnosis and Management of Nonalcoholic Fatty Liver Disease

Author Affiliations
  • 1University of Chicago, Chicago, Illinois
JAMA. 2018;320(23):2474-2475. doi:10.1001/jama.2018.17365

Nonalcoholic fatty liver disease affects about 25% of the adult population globally and is strongly associated with metabolic syndrome, affecting most patients who have dyslipidemia, obesity, or type 2 diabetes .1 About 2% to 7% of those with NAFLD have evidence of NASH on liver biopsy with hepatic inflammation and injury.2 Long-standing NAFLD and NASH can result in cirrhosis and its complications, including hepatocellular carcinoma. Currently, NASH ranks as the second most common reason for liver transplant in the United States and will likely surpass hepatitis C in the coming years as the most common. A diagnosis of NAFLD requires evidence of hepatic steatosis (on imaging or histology) in the absence of secondary causes of steatosis or other liver disease, such as excessive alcohol intake, hepatitis C, Wilson disease, and hepatotoxic medications. Methods to noninvasively assess for advanced fibrosis (bridging fibrosis or cirrhosis) are evolving and can help target which patients should receive a liver biopsy and, potentially, pharmacologic therapy.

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