The American Association for the Study of Liver Diseases (AASLD) has released a practice guidance document addressing the clinical assessment and management of non-alcoholic fatty liver disease (NAFLD), which can progress to fibrosis and cirrhosis. NAFLD encompasses both non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), with the latter involving inflammation. The condition is commonly associated with obesity, type 2 diabetes, hypertension, dyslipidaemia, and insulin resistance.

The document highlights that standard B-mode ultrasound is not recommended for identifying hepatic steatosis due to its low sensitivity. Instead, primary care clinicians should screen patients at risk for NAFLD using the fibrosis-4 (FIB-4) index, which incorporates patient age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count.

Diet and exercise, along with weight reduction for overweight individuals, are emphasised as the foundation of treatment for NAFLD. Patients are also advised to abstain from alcohol.

In a recent study published in the American Journal of Gastroenterology (AJG), researchers disputed the recommendation against using ultrasound for diagnosing hepatic steatosis, suggesting that contemporary ultrasound equipment has acceptable sensitivity. The study involved 5,000 patients across multiple centres and found that ultrasound had a sensitivity of 89% and specificity of 81% for detecting any degree of steatosis. While the debate on ultrasound usage continues, the AASLD guidance remains cautious due to older data.

Overall, this practice guidance document serves as a comprehensive resource for primary care clinicians and specialists, offering detailed insights into the assessment and management of NAFLD. It emphasises the importance of early detection, lifestyle modifications, and appropriate referrals to specialists for further evaluation and intervention.