The American Association for the Study of Liver Diseases
(AASLD) published new guidance on diagnosing and treating fatty liver disease. They recommend providers screen at-risk patients with the FIB-4 score
and refer those with a value of 1.3 or more for vibration-controlled transient elastography (Fibroscan) or an enhanced liver fibrosis (ELF) test, a blood assay that measures levels of three direct markers of liver fibrosis. Weight loss and exercise were recommended for treatment, while pioglitazone, vitamin E, and semaglutide were weakly endorsed in select patients.
Using their guidance, a fifty-year-old with an AST of 42, ALT of 30, and platelet count of 280,000 (FIB-4 of 1.37) would be referred for a Fibroscan (typically at a specialist's office) or ELF test. Given our state of rampant obesity, the cost of following these guidelines would add up quickly.
The caveat of fatty liver disease has always been its treatment, weight loss and exercise, two things most patients already know they should be doing. Referring these patients for expensive care so they can be told something they already know doesn't seem productive. For those who progress to cirrhosis (around 6% of all fatty liver patients), biannual hepatocellular screening is indicated.