Clinical assessment for high-risk patients with non-alcoholic fatty liver disease in primary care and diabetology practices

Zobair M. Younossi*, Kathleen E. Corey, Naim Alkhouri, Mazen Noureddin, Ira Jacobson, Brian Lam, Stephen Clement, Rita Basu, Stuart Gordon, Natarajan Ravendhra, Puneet Puri, Mary Rinella, Peter Scudera, Ashwani K. Singal, Linda Henry

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


Background: Primary care practitioners (PCPs) and diabetologists are at the frontline of potentially encountering patients with NASH. Identification of those at high risk for adverse outcomes is important. Aim: To provide practical guidance to providers on how to identify these patients and link them to specialty care. Methods: US members of the Global Council on NASH evaluated the evidence about NASH and non-invasive tests and developed a simple algorithm to identify high-risk NASH patients for diabetologists and primary care providers. These tools can assist frontline providers in decision-making and referral to gastroenterology/hepatology practices for additional assessments. Results: The presence of NASH-related advanced fibrosis is an independent predictor of adverse outcomes. These patients with NASH are considered high risk and referral to specialists is warranted. Given that staging of fibrosis requires a liver biopsy, non-invasive tests for fibrosis would be preferred. Consensus recommendation from the group is to risk-stratify patients based on metabolic risk factors using the FIB-4 as the initial non-invasive test due to its simplicity and ease of use. A FIB-4 score ≥1.3 can be used for further assessment and linkage to specialty care where additional technology to assess liver stiffness or serum fibrosis test will be available. Conclusion: Due to the growing burden of NAFLD and NASH, PCPs and diabetologists are faced with increased patient encounters in their clinical practices necessitating referral decisions. To assist in identifying high-risk NASH patients requiring specialty care, we provide a simple and easy to use algorithm.

Original languageEnglish (US)
Pages (from-to)513-526
Number of pages14
JournalAlimentary Pharmacology and Therapeutics
Issue number3
StatePublished - Aug 1 2020

ASJC Scopus subject areas

  • Gastroenterology
  • Pharmacology (medical)
  • Hepatology


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