Identification of high-risk subjects in NAFLD.

Non-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease, and its burden is expected to increase because of the growing epidemic of obesity and diabetes. The key challenge is to identify among NAFLD patients those with advanced fibrosis (F3F4), who are at high risk of developing complications and who will benefit from specialized management and treatment with new pharmacotherapies when they are approved. Liver biopsy appears unrealistic and unsuitable in practice given the large number of high-risk patients and its well-known limitations. Non-invasive sequential algorithms using FIB-4 as first-line test followed by vibration controlled transient elastography or patented blood test, are the best strategy for case finding of high-risk subjects. They are now recommended by several international guidelines, and they should be used and disseminated to increase awareness of physicians beyond liver clinics where most NAFLD patients are seen.