Nonalcoholic Steatohepatitis Diagnosis and Management

Diagnostic Criteria

The American Association for the Study of Liver Diseases recommends that a diagnosis of nonalcoholic fatty liver disease (NAFLD) be considered in patients with elevated liver enzymes and metabolic risk factors, particularly if the AST:ALT ratio is <1, which is characteristic of NAFLD 1, 2
The presence of mildly elevated serum ferritin in patients with NAFLD does not necessarily indicate increased iron stores, but rather reflects metabolic dysregulation 2

The FIB-4 score, which is calculated using age, ALT, AST, and platelet count, can be used to determine the risk of advanced fibrosis in patients with NAFLD, with a score <1.3 indicating low risk and a score >2.67 indicating high risk 3, 1, 4

The American Association for the Study of Liver Diseases recommends that patients with NAFLD undergo evaluation for metabolic syndrome components, including obesity, type 2 diabetes, hypertension, and dyslipidemia 3, 1
Lifestyle modifications, including a low-carbohydrate, low-fructose diet and 150-300 minutes of moderate-intensity aerobic exercise weekly, are recommended as the cornerstone of treatment for NAFLD 3, 4
Targeting 7-10% body weight loss through caloric restriction is also recommended 3, 4

Repeat liver enzymes should be checked in 2-4 weeks to establish a trend, and if ALT increases to >5× ULN or remains elevated ≥6 months, referral to hepatology is recommended 4, 3, 1