A Review of Western and Traditional Chinese Medical Approaches to Managing Nonalcoholic Fatty Liver Disease

Table 2

AASLD, EASL, and APASL guidelines for diagnosing and managing NAFLD.

Association	AASLD [1]	EASL [14]	APASL [27]
Evaluate liver fibrosis	NAFLD fibrosis score	Combination of serum markers and imaging method (elastometry)	None
Indication for liver biopsy	(i) NAFLD patients at increased risk of steatohepatitis and advanced fibrosis; (ii) Metabolic syndrome and the NAFLD fibrosis score may be used to identify patients at risk	(i) Noninvasive methods to evaluate fibrosis in patients with insulin resistance, increased ALT, or steatosis; (ii) Liver biopsy in advance-fibrotic patients with evidence of noninvasive methods or insufficient data to exclude advanced fibrosis	(i) Diagnostic uncertainty; (ii) Risk of advanced hepatic fibrosis without evidence of cirrhosis; (iii) Clinical trial; (iv) Subject to laparoscopy for another purpose, such as cholecystectomy, gastric banding
Lifestyle intervention	(i) 3–5% weight loss to improve steatosis, a greater weight loss (>7% to 10%) to improve necroinflammation; (ii) Exercise	(i) Physical exercise, 5–10% weight loss (aim: 7%), dietary changes; (ii) Reassess after 6 months; (iii) Avoid fructose corn syrup and industrial trans-fats	(i) Diet, increasing physical activity (aerobic exercise), weight reduction; (ii) Bariatric surgery or gastric ballooning should be considered in patients without response to lifestyle measures
Medications	(i) Pioglitazone in patients with biopsy-proven NASH; long-term safety and efficacy were not established; (ii) Vitamin E (800 IU/day) for nondiabetic adult with biopsy-proven NASH; (iii) Statins can be used to treat dyslipidemia in patients with NAFLD; (iv) UDCA and omega-3 fatty acids were not recommended	(i) Correct concurrent metabolic disorders; (ii) Suggest further therapeutic trials	Statin for NAFLD and usual indications
Other	Assess for metabolic risk factors and alternative etiologies for NASH		Monitor abdominal girth, body weight, fasting blood glucose, serum lipid, blood pressure and screening cancers increased by metabolic syndrome

AASLD: American Association for the Study of Liver Disease; ALT: alanine aminotransferase; APASL: the Asian Pacific Association for the Study of the Liver; EASL: European Association for the Study of the Liver; NAFLD: nonalcoholic fatty liver disease; NASH: nonalcohol steatohepatitis; UDCA: ursodeoxycholic acid.