Diagnosis and Management of Non-Alcoholic Fatty Liver Disease

AASLD develops evidence-based practice guidelines and practice guidances which are updated regularly by a committee of hepatology experts and include recommendations of preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. 

Practice Guidance

The Diagnosis and Management of Non-Alcoholic Fatty Liver Disease [updated January 2018]

For defining Nonalcoholic Fatty Liver Disease (NAFLD), there must be (1) evidence of hepatic steatosis (HS), either by imaging or histology, and (2) lack of secondary causes of hepatic fat accumulation such as significant alcohol consumption, longterm use of a steatogenic medication, or monogenic hereditary disorders. In the majority of patients, NAFLD is commonly associated with metabolic comorbidities such as obesity, diabetes mellitus, and dyslipidemia. NAFLD can be categorized histologically into nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis. NAFL is defined as the presence of 5% HS without evidence of hepatocellular injury in the form of hepatocyte ballooning. NASH is defined as the presence of 5% HS and inflammation with hepatocyte injury (e.g., ballooning), with or without any fibrosis. For defining “advanced” fibrosis, this guidance document will be referring specifically to stages 3 or 4, that is, bridging fibrosis or cirrhosis.

Supplemental Materials

This AACE guideline provides evidence-based recommendations regarding the diagnosis and management of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) to endocrinologists, primary care clinicians, health care professionals, and other stakeholders. It was co-sponsored by AASLD.

American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Setting [updated May 2022]