Practice guidelines for the diagnosis and management of nonalcoholic fatty liver disease: A decalogue from the Italian Association for the Study of the Liver (AISF) Expert Committee

The 8–10 year natural history of NAFLD.

Uncomplicated “pure” nonalcoholic fatty liver will rarely (if ever) progress to NASH [41]. In contrast, a proportion of patients with NASH may have cirrhosis at diagnosis or will evolve to cirrhosis during follow-up . Cirrhosis may lead to liver-related death with or without [39] the development of HCC.

Modified from [32], according to Refs. .

A practical approach to NAFLD (based on paragraphs 4–6).

In the absence of specific chemicals, viral, autoimmune and genetic aetiology, raised liver enzymes are most commonly associated with NAFLD.

NAFLD may be suspected owing to increased levels of liver enzymes and/or compatible ultrasonographic findings. Ultrasound scanning should be performed in every patient. History, physical examination and appropriate laboratory tests will reinforce the diagnosis of NAFLD and contribute to ruling out alternative etiologies. The coexistence of specific indicators of the metabolic syndrome will result in enhanced clinical probability of progressive disease (NASH/Fibrosis). Liver biopsy should be reserved to those patients presenting risk factors for NASH/fibrosis such as those listed in Table 3.

Lifestyle modification (in the absence of risk factors) and pharmacological therapeutic interventions, possibly in the context of RCTs (in the presence of NASH and fibrosis) may be adopted in the individual patient.