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Nonalcoholic Fatty Liver Disease

Identification and Management of High-Risk Patients

Cheung, Amanda, MD1; Figueredo, Carlos, MD2; Rinella, Mary E., MD3

American Journal of Gastroenterology: April 2019 - Volume 114 - Issue 4 - p 579–590
doi: 10.14309/ajg.0000000000000058

Nonalcoholic fatty liver disease (NAFLD) is an increasingly dominant cause of liver disease worldwide. The progressive subtype, nonalcoholic steatohepatitis, is a leading indication for liver transplantation and a noteworthy cause of hepatocellular carcinoma. The overall prevalence of NAFLD is on the rise, and even more concerning data modeling predicts that an increasing percentage of those with NAFLD will develop advanced disease. This increased volume of patients with advanced liver disease will impose a significant health care burden in terms of resources and cost. Thus, the identification of patients with established fibrosis or at high risk of developing advanced liver disease is critical to effectively intervene and prevent overall and liver-related morbidity and mortality. Herein, we provide a framework to consider for the identification of patients with NAFLD at high risk of nonalcoholic steatohepatitis with advanced fibrosis and provide a critical assessment of currently accessible diagnostic and treatment modalities.

1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA;

2Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronk, NY;

3Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Correspondence: Mary E. Rinella, MD. E-mail:

The first two authors are co-primary authors.

Received April 25, 2018

Accepted November 08, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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