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Hepatic Steatosis: An Incidental Finding That Deserves Attention

Nonalcoholic fatty liver disease (NAFLD) is a public health crisis and the most common chronic liver disease in the US with a current prevalence of 25% in US adults and rising.1-3 NAFLD results from the accumulation of fat within hepatocytes in patients without a history of heavy alcohol use or other causes (e.g., medication, hepatitis C). NAFLD is a spectrum of disease ranging from simple steatosis (NAFL) to steatohepatitis (NASH), fibrosis, and cirrhosis. NAFLD is associated with risk for hepatocellular carcinoma, need for liver transplantation, type 2 diabetes, chronic kidney disease, and cardiovascular disease.1,4 Risk for these complications increases with the degree of fibrosis.2,5 Identifying advanced fibrosis previously required expensive and invasive liver biopsy, but recently several biomarkers and scoring systems can reliably establish risk for advanced fibrosis. The fibrosis-4 (FIB-4) index is a well-validated tool that uses common clinical information (patient age, ALT, AST, and platelet count) to estimate risk of advanced fibrosis (low, indeterminate, and high) in patients with hepatic steatosis.5-7.