Diagnostic evaluation of nonalcoholic fatty liver disease

Leon A. Adams, Jayant A. Talwalkar

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a diagnostic consideration among patients with asymptomatic elevated aminotransaminases, patients with radiologic findings of hepatic fatty infiltration, or occasionally in the patient with "cryptogenic" cirrhosis. The diagnosis of NAFLD requires evidence of fatty infiltration of the liver in the absence of excessive alcohol ingestion. Clinical evaluation should examine for metabolic risk factors (central obesity, glucose intolerance, hypertension, hypertriglyceridemia, and low HDL cholesterol), which are suggestive but not specific for the diagnosis of NAFLD. Secondary causes of NAFLD, such as medications and intestinal bypass surgery, should be excluded as management of these conditions may differ. Confirmation of hepatic steatosis can usually be done by imaging studies, although occasionally liver biopsy is required. Among suspected NAFLD patients with chronically elevated aminotransaminases, clinical evaluation and serological testing should be performed to exclude other causes of chronic liver disease. Liver biopsy is required to stage fibrosis and distinguish between nonalcoholic steatohepatitis and steatosis. This is valuable for providing prognosis, excluding other liver disease, monitoring response to therapy or evaluating disease progression over time. Clinical features, particularly diabetes, obesity, and older age, can aid in stratifying patients at risk for advanced fibrosis but are not sufficiently accurate to replace liver biopsy.

Original languageEnglish (US)
JournalJournal of Clinical Gastroenterology
Volume40
Issue numberSUPPL. 1
DOIs
StatePublished - Mar 2006

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Liver
Biopsy
Liver Diseases
Fibrosis
Jejunoileal Bypass
Glucose Intolerance
Abdominal Obesity
Hypertriglyceridemia
Fatty Liver
HDL Cholesterol
Disease Progression
Non-alcoholic Fatty Liver Disease
Chronic Disease
Obesity
Eating
Alcohols
Hypertension
Therapeutics
Cryptogenic Cirrhosis

Keywords

  • Diagnosis
  • Liver biopsy
  • Nonalcoholic fatty liver disease

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Diagnostic evaluation of nonalcoholic fatty liver disease. / Adams, Leon A.; Talwalkar, Jayant A.

In: Journal of Clinical Gastroenterology, Vol. 40, No. SUPPL. 1, 03.2006.

Research output: Contribution to journalArticle

Adams, Leon A. ; Talwalkar, Jayant A. / Diagnostic evaluation of nonalcoholic fatty liver disease. In: Journal of Clinical Gastroenterology. 2006 ; Vol. 40, No. SUPPL. 1.
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