1 Divisions of General Internal Medicine.
2 Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA; Malcom Randall VAMC, Gainesville, FL, USA. Electronic address: Kenneth.Cusi@medicine.ufl.edu.
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States and soon to be the leading cause of liver transplantation. Patients at the greatest risk are those with obesity and type 2 diabetes mellitus. In 2019 the American Diabetes Association guidelines for the first time called for clinicians to screen for steatohepatitis and fibrosis all patients with type 2 diabetes and liver steatosis or abnormal plasma aminotransferases. This demands primary care physicians (PCPs) to be aware of key aspects related to the diagnosis and treatment of NAFLD as well as to when to refer to a specialist. Unfortunately, there is still significant medical inertia as clinicians remain unaware of its high morbidity/mortality. Early diagnosis in the primary care setting is critical to prevent progression to end-stage liver disease. Patients with NAFLD are also at a higher risk of developing type 2 diabetes mellitus and cardiovascular disease. Despite general perception to the contrary, weight loss by lifestyle intervention or bariatric surgery and several pharmacological treatments (e.g., vitamin E in non-diabetics, pioglitazone or GLP-1RAs in patients with or without diabetes) can often be successful to reverse steatohepatitis and prevent disease progression.