Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

Naga Chalasani, MD, FACG1, Zobair Younossi, MD, FACG2, Joel E. Lavine, MD, PhD3, Anna Mae Diehl, MD4, Elizabeth M. Brunt, MD5, Kenneth Cusi, MD6, Michael Charlton, MD7 and Arun J. Sanyal, MD8

1Indiana University School of Medicine, Indianapolis, Indiana, USA; 2Department of Medicine, Center for Liver Disease, InovaFairfax Hospital, New York, New York, USA; 3Falls Church Columbia University, New York, New York, USA; 4Duke University, Durham, North Carolina, USA; 5Washington University, St Louis, Missouri, USA; 6University of Florida, Gainesville, Florida, USA; 7Mayo Clinic, Rochester, Minnesota, USA; 8Virginia Commonwealth University, Richmond, Virginia, USA.

Am J Gastroenterol 2012; 107: 811– 826; doi: 10.1038/ajg.2012.128; published online 29 May 2012
Submitted for Governing Board approval by AASLD, ACG, and AGA on 22 February 2012.
This article is being published jointly in 2012 in Gastroenterology, American Journal of Gastroenterology, and Hepatology.
Received 4 April 2012; accepted 4 April 2012

Correspondence: Naga Chalasani, MD, FACG, Medicine and Cellular and Integrative Physiology, Director, Division of Gastroenterology & Hepatology, Indiana University School of Medicine, RG 4100, 1050 Wishard Boulevard, Indianapolis, Indiana 46202, USA. E-mail: nchalasa@iupui.edu


These recommendations are based on the following: (i) a formal review and analysis of the recently published world literature on the topic (Medline search up to June 2011); (ii) the American College of Physicians’ Manual for Assessing Health Practices and Designing Practice Guidelines; (1) (iii) guideline policies of the three societies approving this document; and (iv) the experience of the authors and independent reviewers with regards to non-alcoholic fatty liver disease (NAFLD).

Intended for use by physicians and allied health professionals, these recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. They are intended to be flexible and adjustable for individual patients. Specific recommendations are evidence based wherever possible, and when such evidence is not available or inconsistent, recommendations are made based on the consensus opinion of the authors. To best characterize the evidence cited in support of the recommendations, the AASLD Practice Guidelines Committee has adopted the classification used by the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) workgroup with minor modifications (Table 1) (2). The strength of recommendations in the GRADE system is classified as strong (1) or weak (2). The quality of evidence supporting strong or weak recommendations is designated by one of three levels: high (A), moderate (B), or low quality (C) (2). This is a practice guideline for clinicians rather than a review article and interested readers can refer to several comprehensive reviews published recently (3,4,5,6,7,8).

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