Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the Strength of Recommendation Taxonomy (SORT) evidence rating system, go to https://www.aafp.org/afp/2004/0201/p548.

1. In patients with metabolic dysfunction–associated steatotic liver disease, initiate treatment for stage F2 fibrosis or higher. In addition, weight loss with a goal of at least 10% should be attempted through lifestyle modifications or pharmacologic treatment in metabolic dysfunction–associated steatohepatitis with stage F2 or F3 fibrosis from metabolic dysfunction–associated steatotic liver disease.
Evidence rating: SORT A
Source: Section One, reference 27

2. In patients with metabolic dysfunction–associated steatotic liver disease, use glucagon-like peptide-1 receptor agonists to treat metabolic dysfunction–associated steatohepatitis with stage F2 or F3 fibrosis if lifestyle modifications are unsuccessful.
Evidence rating: SORT A
Source: Section One, reference 38

3. Screen all adults 18 and older for hepatitis C.
Evidence rating: SORT B
Sources: Section Two, references 22 and 36

4. Offer adults with hepatitis C infection who are eligible for simplified treatment either sofosbuvir/velpatasvir (Epclusa) for 12 weeks or glecaprevir/pibrentasvir (Mavyret) for 8 weeks.
Evidence rating: SORT A
Source: Section Two, reference 25

5. Screen all adults 18 years or older, including pregnant women, for unhealthy alcohol use.
Evidence rating: SORT A
Sources: Section Three, references 5 and 6

6. Recommend alcohol avoidance for patients with alcohol-associated liver disease at any stage.
Evidence rating: SORT A
Source: Section Three, reference 6

7. Screen first-degree relatives of patients with Wilson disease for variations in the ATP7B gene.
Evidence rating: SORT C
Sources: Section Four, references 8 and 35

8. Use phlebotomy as first-line therapy to reduce and maintain the ferritin level at 50 to 100 ng/mL (50 to 100 mcg/L) in patients with hemochromatosis and C282Y/C282Y homozygosity in the HFE gene.
Evidence rating: SORT C
Sources: Section Four, references 10, 12, and 53