American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD)

Kenneth Cusi; Scott Isaacs; Diana Barb; Rita Basu; Sonia Caprio; W Timothy Garvey; Sangeeta Kashyap; Jeffrey I Mechanick; Marialena Mouzaki; Karl Nadolsky; Mary E Rinella; Miriam B Vos; Zobair Younossi

doi:10.1016/j.eprac.2022.03.010

American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD)

Endocr Pract. 2022 May;28(5):528-562. doi: 10.1016/j.eprac.2022.03.010.

Authors

Affiliations

¹ Guideine and Algorithm Task Forces Co-Chair, Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida.
² Guideline and Algorithm Task Forces Co-Chair, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia.
³ University of Florida, Gainesville, Florida.
⁴ Division of Endocrinology, University of Virginia School of Medicine, Charlottesville, Virginia.
⁵ Yale University School of Medicine, New Haven, Connecticut.
⁶ Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama.
⁷ Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
⁸ The Marie-Josee and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai.
⁹ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
¹⁰ Michigan State University College of Human Medicine, Grand Rapids, Michigan.
¹¹ AASLD Representative, University of Pritzker School of Medicine, Chicago, Illinois.
¹² Center for Clinical and Translational Research, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
¹³ AASLD Representative, Inova Medicine, Inova Health System, Falls Church, Virginia.

PMID: 35569886
DOI: 10.1016/j.eprac.2022.03.010

Abstract

Objective: To provide 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.

Methods: The American Association of Clinical Endocrinology conducted literature searches for relevant articles published from January 1, 2010, to November 15, 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established American Association of Clinical Endocrinology protocol for guideline development.

Recommendation summary: This guideline includes 34 evidence-based clinical practice recommendations for the diagnosis and management of persons with NAFLD and/or NASH and contains 385 citations that inform the evidence base.

Conclusion: NAFLD is a major public health problem that will only worsen in the future, as it is closely linked to the epidemics of obesity and type 2 diabetes mellitus. Given this link, endocrinologists and primary care physicians are in an ideal position to identify persons at risk on to prevent the development of cirrhosis and comorbidities. While no U.S. Food and Drug Administration-approved medications to treat NAFLD are currently available, management can include lifestyle changes that promote an energy deficit leading to weight loss; consideration of weight loss medications, particularly glucagon-like peptide-1 receptor agonists; and bariatric surgery, for persons who have obesity, as well as some diabetes medications, such as pioglitazone and glucagon-like peptide-1 receptor agonists, for those with type 2 diabetes mellitus and NASH. Management should also promote cardiometabolic health and reduce the increased cardiovascular risk associated with this complex disease.

Keywords: GLP-1 RA; NAFLD; diabetes; pioglitazone; steatohepatitis; weight loss.

Publication types

Practice Guideline
Review

MeSH terms

Diabetes Mellitus, Type 2* / drug therapy
Glucagon-Like Peptide-1 Receptor
Humans
Non-alcoholic Fatty Liver Disease* / complications
Non-alcoholic Fatty Liver Disease* / diagnosis
Non-alcoholic Fatty Liver Disease* / therapy
Obesity / complications
Primary Health Care
United States / epidemiology
Weight Loss

Substances

Glucagon-Like Peptide-1 Receptor