Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1598
Peer-review started: March 7, 2022
First decision: June 8, 2022
Revised: June 30, 2022
Accepted: August 10, 2022
Article in press: August 10, 2022
Published online: August 27, 2022
Processing time: 171 Days and 17 Hours
There is an urgent need to risk stratify patients with suspected nonalcoholic fatty liver disease (NAFLD) and identify those with fibrotic nonalcoholic steatohepatitis. This study aims to apply a simple diagnostic algorithm to identify subjects with at-risk NAFLD in the general population.
To apply a simple diagnostic algorithm to identify subjects with at-risk NAFLD in the general population.
Adult subjects were included from the National Health and Nutrition Exam
Three thousand six hundred and sixty-nine patients were identified who met all inclusion and exclusion criteria. From this cohort, 911 (28.6%) patients had elevated ALT of which 236 (22.9%) patients had elevated FIB4 scores ≥ 1.3. Among patients with elevated FIB4 score, 75 (24.4%) had elevated FAST scores, ruling in advanced fibrosis. This accounts for 2.0% of the overall study population. Applying this algorithm to 737 patients with T2DM, 213 (35.4%) patients had elevated ALT, 85 (37.9%) had elevated FIB4, and 42 (46.1%) had elevated FAST scores. This accounts for 5.7% of the population with T2DM.
The application of this algorithm to identify at-risk NAFLD patients in need for specialty care is feasible and demonstrates that the vast majority of patients do not need subspecialty referral for NAFLD.
Core Tip: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis represent a major public health threat as the incidence and prevalence continues to rise. This patient population has the potential to overwhelm hepatology clinics if not appropriately triaged by those physicians making referrals. This manuscript presents a simple diagnostic algorithm that outlines how physicians can approach an undifferentiated patient with findings concerning for NAFLD.