Site Editor



Best Practice Update From the AGA for Lean Individuals With Non-Alcoholic Fatty Liver Disease

By: Lauren Harrison, MD, MS
Posted: Friday, September 30, 2022

The American Gastroenterological Association (AGA) published a clinical practice update in Gastroenterology providing advice on how to diagnose and manage lean individuals who develop non-alcoholic fatty liver disease. Studies have demonstrated that this condition among lean individuals may be linked to an increased cardiovascular, liver, and all-cause mortality relative to those without this condition.

“About 10% of those with [non-alcoholic fatty liver disease] are lean, and traditionally this group has been even more difficult to diagnose, as the condition often goes unrecognized,” said Michelle T. Long, MD, MSc, of Boston University School of Medicine, in an institutional press release.

This review was commissioned by the AGA Institute Clinical Practice Updates Committee and the AGA governing board. Prior to publication, it underwent internal peer review by the Clinical Practice Updates Committee. There were 15 best practice guidelines included in the publication, and here are briefly some of the best practice statements.

Non-alcoholic fatty liver disease should be diagnosed in individuals with a body mass index less than 15 kg/m2 who have non-alcoholic fatty liver disease. These individuals should be routinely evaluated for comorbid conditions, including type 2 diabetes mellitus, dyslipidemia, and hypertension. Patients should be risk-stratified for hepatic steatosis to identify those who may have advanced fibrosis or cirrhosis. Screening for non-alcoholic fatty liver disease should occur in lean individuals with metabolic diseases, elevated liver biochemical tests, or incidentally noted hepatic steatosis.

Serum indices such as the non-alcoholic fatty liver disease fibrosis score and Fibrosis-4 score as well as imaging techniques can be used as alternatives to liver biopsy for fibrosis staging and follow-up. However, these noninvasive tests are indeterminate, the clinical practice update noted, and a second noninvasive test is needed to confirm the stage and prognosis of non-alcoholic fatty liver disease. In addition, screening for hepatocellular carcinoma with an abdominal ultrasound with or without assessment of alpha-fetoprotein levels should occur twice a year among lean patients with non-alcoholic fatty liver disease and clinical markers of liver cirrhosis.

Disclosures: For a full list of authors’ disclosures, visit

By continuing to browse this site you permit us and our partners to place identification cookies on your browser and agree to our use of cookies to identify you for marketing. Read our Privacy Policy to learn more.