The American Gastroenterological Association has issued a new clinical practice update focused on the diagnosis, staging, and management of nonalcoholic fatty liver disease (NAFLD) in lean individuals. Dr. Mazen Noureddin highlights that NAFLD in lean individuals, defined as those with a BMI of less than 25 (or less than 23 for Asian populations), should be approached similarly to NAFLD in overweight or obese patients, particularly if they have comorbidities like type 2 diabetes or metabolic syndrome. The update emphasizes the importance of ruling out secondary causes of liver disease, such as alcohol use or rare conditions. It also suggests screening lean individuals, especially those over 40 with type 2 diabetes, using non-invasive tools like Fib-4 and transient elastography.

For diagnosis, the update recommends that primary care providers initiate the evaluation with non-invasive tests, while hepatology or gastroenterology clinics may conduct further assessments using advanced imaging or scoring systems. Management strategies remain consistent with those for NAFLD in other populations, with weight loss, dietary modifications, and certain medications like vitamin E and pioglitazone being recommended.

Reference: American Gastroenterological Association. Clinical Practice Update: Diagnosis and Management of NAFLD in Lean Individuals. YouTube. Published September 12, 2022. Accessed August 20, 2024. https://www.youtube.com/watch?v=BtLJQ9POemw