Nonalcoholic Fatty Liver Disease: Identification and Management of High-Risk Patients

Am J Gastroenterol. 2019 Apr;114(4):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.

Publication types

  • Review

MeSH terms

  • Biomarkers / analysis
  • Biopsy
  • Diagnostic Imaging
  • Diet
  • Disease Progression
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Life Style
  • Liver Transplantation
  • Non-alcoholic Fatty Liver Disease / diagnosis*
  • Non-alcoholic Fatty Liver Disease / therapy*
  • Pioglitazone / therapeutic use
  • Vitamin E / therapeutic use


  • Biomarkers
  • Hypoglycemic Agents
  • Vitamin E
  • Pioglitazone