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5MinuteConsult Journal Club

NAFLD Screening and Treatment Guidelines


Endocrine Practice; 2022; 28(5): 528-62;


The American Academy of Clinical Endocrinologists (AACE) just released their 2022 Nonalcoholic Fatty Liver Guidelines (NAFLD). NAFLD affects approximately 30% of US adults. The guidelines are simple and easy to implement.

Key Points

Screen all patients with conditions like obesity & T2DM, or 2 or more metabolic syndrome risk factors by obtaining ALT and AST levels. Even if they are within the normal range, determine the ALT/AST ratio.

If the ALT/AST >1; calculate a FIB 4 Score ( and obtain an ultrasound of the RUQ.

If FIB-4 Score is

If the FIB-4 Score is >1.3, do the very same thing, but additionally obtain Liver Stiffness test (like a Fibroscan) and refer to GI as the risk for progression to cirrhosis is high.

The AACE emphasize ALT and AST measures that are within the “normal range” can still be consistent with NAFLD, so use the ratio to guide your efforts.

One additional thought; other things may alter the ALT/AST ratio, for instance if less than 1.0, be sure to take a detailed alcohol history. If the ultrasound does not show fatty infiltration of the liver, consider other metabolic disorders like celiac and thyroid dysfunction.

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Contributed by Frank J. Domino, June 22, 2022