COMMENTARY

The Emerging Epidemic of Nonalcoholic Fatty Liver Disease

Rowen K. Zetterman, MD

Disclosures

January 21, 2011

In This Article

Who Should Be Screened for NAFLD?

Practitioners should screen the following patients:

  • Those who manifest components of metabolic syndrome, including truncal obesity, increased waist circumference, hyperlipidemia, and type 2 diabetes mellitus, and those with systemic hypertension and other features of metabolic syndrome;

  • Those with morbid obesity;

  • Those with fatty liver at radiologic testing;

  • Those with elevation of serum aminotransferases;

  • Those with elevated aminotransferases and suspect medications;

  • Those with rapid weight loss and elevated aminotransferases; and

  • Those being considered for surgical therapy of obesity.

How Should You Screen for NAFLD?

Although liver histology is the gold standard for diagnosis of NAFLD, patients can be screened by a careful history and physical examination that includes looking for associated conditions or hepatomegaly, assessment of serum aminotransferases and laboratory studies suggestive of metabolic syndrome, and ruling out other causes of liver disease, such as alcoholism, hemochromatosis, and hepatitis B or C. Radiographic imaging with liver ultrasound ("bright liver") or abdominal CT or MRI suggesting fatty liver, hepatomegaly, or complications of advanced liver disease can be used. Ultrasound of the liver is considered first-line screening for most patients.[4] Patients should also be monitored for the increased cardiovascular risk associated with NAFLD.[41]

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