AASLD Practice Guidance for NAFLD

Chalasani et al. • Hepatology

Key Finding

Weight loss of ≥7-10% improves liver histology; lifestyle modification is first-line treatment for NAFLD.

Original title: “The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from AASLD”

Plain English Summary

Comprehensive practice guidance from American Association for Study of Liver Diseases covering diagnosis, screening, and management of NAFLD/NASH.

In-Depth Analysis

Background

The American Association for the Study of Liver Diseases (AASLD) published this practice guidance in Hepatology (PMID: 28714183). Lead author Dr. Naga Chalasani from Indiana University School of Medicine coordinated expert consensus on NAFLD/NASH diagnosis and management.

Study Design

Systematic evidence review with expert consensus to develop practical clinical guidance. Evaluated diagnostic methods, screening strategies, and therapeutic interventions for nonalcoholic fatty liver disease.

Key Findings

Diagnostic approach:

•Exclude significant alcohol consumption (>21 drinks/week men, >14 women)
•Rule out other causes of hepatic steatosis
•Imaging confirms steatosis; biopsy for NASH/fibrosis staging

Treatment recommendations:

Intervention	Evidence Level	Recommendation
Weight loss ≥7-10%	High	First-line for all NAFLD
Vitamin E 800 IU	Moderate	Non-diabetic NASH
Pioglitazone	Moderate	Biopsy-proven NASH
Bariatric surgery	Moderate	Eligible patients with NASH

Mechanistic Insights

NAFLD represents hepatic manifestation of metabolic syndrome. Insulin resistance drives hepatic de novo lipogenesis, leading to steatosis. Lipotoxicity and oxidative stress cause progression to NASH and fibrosis.

Clinical Implications

7-10% weight loss is the most effective intervention, achieving histological improvement in majority of patients. Pharmacotherapy reserved for biopsy-proven NASH. Regular cardiovascular risk assessment essential as CVD is leading cause of death in NAFLD.

Metabolic Health Perspective

NAFLD is a metabolic disease requiring metabolic solutions. Carbohydrate restriction effectively reduces hepatic de novo lipogenesis. FLI and other non-invasive scores help identify patients for aggressive metabolic intervention.