From the Guidelines
Non-Alcoholic Fatty Liver Disease (NAFLD) Laboratory Workup The recommended laboratory workup for NAFLD includes liver biochemistries (ALT, AST) to assess liver function, as well as tests to exclude other liver diseases, such as hepatitis B and C serology, and autoimmune liver disease panel including antinuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA) 1.
Initial Evaluation
- Liver Function Tests (LFTs): aspartate aminotransferase (AST), alanine aminotransferase (ALT) to evaluate liver damage
- Hepatitis B and C serology: to exclude other liver diseases
- Autoimmune liver disease panel: including antinuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA) to rule out autoimmune hepatitis
- Serum ferritin: to assess for iron overload
- Alpha-1 antitrypsin level: if suspected deficiency
- Imaging studies: such as abdominal ultrasound to assess liver morphology and rule out other liver diseases
Additional Tests
- Lipid profile: to evaluate dyslipidemia
- Fasting glucose and hemoglobin A1c (HbA1c): to assess for diabetes and insulin resistance
- Thyroid-stimulating hormone (TSH): to rule out hypothyroidism
- Vitamin B12 and D levels: to assess for deficiencies
- Iron studies: including serum iron, total iron-binding capacity (TIBC), and ferritin to evaluate iron overload
Risk Stratification
The Fibrosis 4 Index (FIB-4) can be used as a first-line point-of-care test to assess the risk of advanced hepatic fibrosis, and patients with a high risk should undergo further evaluation with enhanced liver fibrosis (ELF), vibration-controlled elastography (VCTE), or magnetic resonance elastography (MRE) 1.
Management
Patients with NAFLD should be counseled on lifestyle modifications, including a healthy diet and regular exercise, and may benefit from weight loss and treatment of underlying metabolic conditions, such as statins for dyslipidemia 1.
From the Research
Laboratory Tests for NAFLD Workup
The following laboratory tests are recommended for the workup of Non-Alcoholic Fatty Liver Disease (NAFLD):
- Liver function tests, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 2, 3, 4
- Lipid profiles, including total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol 4
- Fasting glucose and insulin levels to assess for insulin resistance and diabetes 2, 5, 6
- Complete blood count (CBC) and platelet count to evaluate for thrombocytopenia and splenomegaly 3
- Prothrombin time (PT) and international normalized ratio (INR) to assess for coagulopathy 3
- Vibration-controlled transient elastography to assess for liver fibrosis 2, 3
- Fibrosis scores, such as the Fib-4 score, to assess for advanced liver fibrosis 2, 3
Imaging Studies
Imaging studies, such as:
- Abdominal ultrasonography to diagnose fatty liver and assess for liver fibrosis 3
- Liver ultrasound elastography to assess for liver fibrosis 4
- Magnetic resonance imaging (MRI) or computed tomography (CT) scans to evaluate for liver fibrosis and cirrhosis 3
Liver Biopsy
Liver biopsy remains the reference standard for diagnosing nonalcoholic steatohepatitis (NASH) and staging liver fibrosis 2, 5, 6