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Am Fam Physician. 2023;107(5):554-556

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• NAFLD and NASH are common in patients with type 2 diabetes and obesity.

• If testing for NAFLD, start with the fibrosis-4 index, which uses platelet and transaminase measurements. Evaluate intermediate- or higher-risk patients with transient elastography or an enhanced liver fibrosis laboratory panel.

• Weight loss is key to managing NAFLD and NASH; lifestyle interventions, glucagon-like peptide-1 agonists, and bariatric surgery all improve liver disease.

From the AFP Editors 

Nonalcoholic fatty liver disease (NAFLD) affects one-fourth of the global population and is the most common cause of chronic liver disease. Up to 1 in 7 people with NAFLD have a more aggressive form called nonalcoholic steatohepatitis (NASH), which can progress to advanced liver fibrosis, cirrhosis, or liver cancer. Fewer than 1 in 20 people with NAFLD is aware that they have the disease. The American Association of Clinical Endocrinology (AACE) published guidelines for diagnosis and management of NAFLD, cosponsored by the American Association for the Study of Liver Diseases.


Because NAFLD is defined by hepatic steatosis in more than 5% of hepatocytes in a biopsy sample, the prevalence must be estimated. It is important to diagnosis the lack of significant recent or ongoing alcohol consumption or other known causes of liver disease. Significant alcohol use is defined as more than 21 standard drinks per week for men and 14 drinks per week for women.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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