Fatty Liver Disease: Diagnosis and Stratification

Annu Rev Med. 2022 Jan 27:73:529-544. doi: 10.1146/annurev-med-042220-020407. Epub 2021 Nov 22.


Nonalcoholic fatty liver disease (NAFLD) is a major public health crisis affecting approximately 25% of the world's population. The spectrum of NAFLD ranges from bland steatosis to steatohepatitis with fibrosis; eventual development of cirrhosis in a subgroup of patients now represents the leading indication for liver transplant in women and in individuals older than 65. The development of noninvasive liver disease assessment tools has led to substantial progress in the diagnosis of NAFLD. Patients with NAFLD are at increased risk of cardiometabolic disease, which should therefore be an important part of the therapeutic approach. This review focuses on diagnosis and risk stratification of NAFLD across the full spectrum of disease, including important considerations in the approach to patients with cirrhosis.

Keywords: NAFLD; NASH; NILDA; cirrhosis; fatty liver; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis; noninvasive liver disease assessment.

Publication types

  • Review

MeSH terms

  • Female
  • Fibrosis
  • Humans
  • Liver Cirrhosis / diagnosis
  • Liver Transplantation*
  • Non-alcoholic Fatty Liver Disease* / diagnosis
  • Non-alcoholic Fatty Liver Disease* / epidemiology
  • Non-alcoholic Fatty Liver Disease* / therapy