From the Guidelines
To confirm non-alcoholic fatty liver disease (NAFLD), order the following labs:
Initial Evaluation
- Liver function tests (LFTs) including alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase, and total bilirubin 1
- Complete blood count (CBC) to rule out other causes of liver disease
- Basic metabolic panel (BMP) to assess for metabolic syndrome components such as diabetes and hypertension
- Fasting lipid profile to evaluate for dyslipidemia
- Fasting glucose and insulin levels to assess for insulin resistance
Additional Tests
- Iron studies, including serum iron, total iron-binding capacity, and ferritin, to rule out hemochromatosis
- Vitamin B12 level to rule out vitamin B12 deficiency
- Hepatitis panel to rule out viral hepatitis
- Ultrasound or other imaging studies, such as CT or MRI, to assess for fatty liver and rule out other liver diseases 1
Fibrosis Assessment
- Consider ordering a Fib-4 score or enhanced liver fibrosis (ELF) test to assess for fibrosis, especially if liver biopsy is not feasible 1 Note: A liver biopsy may be considered the gold standard for diagnosis, but it is not always necessary and is typically reserved for cases where the diagnosis is unclear or to assess for fibrosis 1
From the Research
Laboratory Tests for Non-Alcoholic Fatty Liver Disease (NAFLD)
To confirm the diagnosis of NAFLD, several laboratory tests can be ordered, including:
- Liver blood tests to evaluate liver function 2
- Fasting blood glucose to assess the risk of diabetes 2, 3
- Triglycerides and HDL levels to evaluate the risk of metabolic syndrome 2
- Biomarkers such as the fatty liver index (FLI) to assess the presence of steatosis 2
Imaging Techniques
Imaging techniques can also be used to confirm the diagnosis of NAFLD, including:
- Ultrasound (US) to visualize the liver and assess the presence of steatosis 2, 4
- Magnetic Resonance Imaging (MRI)-based techniques to quantify steatosis and assess the presence of fibrosis 2, 5
- Elastography to estimate liver stiffness and assess the presence of fibrosis 2, 5
Non-Invasive Tests
Non-invasive tests can be used to assess the severity of NAFLD and monitor disease progression, including:
- NAFLD fibrosis score to assess the risk of fibrosis 2, 5
- Enhanced liver fibrosis (ELF) test to assess the presence of fibrosis 5
- Transient elastography (TE) to estimate liver stiffness and assess the presence of fibrosis 5
- Magnetic resonance elastography (MRE) to estimate liver stiffness and assess the presence of fibrosis 5
Invasive Tests
Invasive tests, such as liver biopsy, can be used to confirm the diagnosis of NAFLD and assess the presence of nonalcoholic steatohepatitis (NASH) and fibrosis 4, 3, 5, 6