Non-alcoholic fatty liver disease screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

There is insufficient evidence to recommend routine screening for NAFLD.But it can be argued that at least for high-risk profiles like obesity, insulin resistance and patients with metabolic syndrome should be screened for NAFLD. However, at present, there are significant gaps in our knowledge regarding the diagnosis, natural history, and treatment of NAFLD.Sometimes patients with normal liver enzyme levels have NAFLD and NASH and maybe not enough for screening alone but with ultrasound which is sensitive can serve as a screening test.

Screening

• There is insufficient evidence to recommend routine screening for NAFLD.
• Most of the time NAFLD is accidental finding on routine ultrasound.
• NAFLD usually has no symptoms. So diagnosing the problem often starts after a blood test finds higher-than-normal levels of liver enzymes. A standard blood test could reveal these results.

Incidental finding of Fatty liver on ultrasound

Check for persistently raised LFTs

Ask the patient for significant alcohol intake

NO

YES

Diagnose NAFLD

Consider other alcoholic related diseases

Monitor severity of the disease

Offer Enhanced Liver Fibrosis Test (ELF)

(>10.51) ELF Positive

(<10.51) ELF Negative

Indicating advanced fibrosis and risk of progression to cirrhosis

Typically Benign -- Advanced fibrosis unlikely

Refer the patient to Heptologist

• On negative ELF test offer retest for every 3 years for adults and 2 years for children.