News Release 

International experts call for a unified public health response to NAFLD and NASH epidemic

Patients with obesity or type 2 diabetes are at a higher risk of developing NAFLD and NASH.

American Gastroenterological Association

Research News

Bethesda, MD (July 26, 2021) -- There is an urgent need to develop and implement effective screening, diagnosis and treatment strategies for patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), common liver conditions with a rising burden in the U.S. and globally. This is particularly important for the most at-risk patients, those with diabetes and obesity.

As a critical first step, the American Gastroenterological Association (AGA) -- in collaboration with seven professional associations -- convened an international conference of 32 experts to develop a multidisciplinary action plan to improve care for the growing population of patients with NAFLD and NASH. Today, the recommendations from this meeting have been co-published in four leading journals: Gastroenterology, Diabetes Care, Metabolism: Clinical and Experimental, and Obesity: The Journal of the Obesity Society.

Key findings from this special report:

  • Patients with obesity or type 2 diabetes are at a higher risk of developing NAFLD/NASH with diabetes being a major risk factor for worse disease severity and progression to cirrhosis (permanent damage to the liver).

  • Primary care providers are critical to managing this growing epidemic. They should be the first line for screening patients at risk, stratifying patients based on their risk for advanced fibrosis, and providing effective management and referrals.

  • The guiding principle for risk stratification is to rule out advanced fibrosis by simple, noninvasive fibrosis scores (such as NAFLD fibrosis score or Fibrosis-4 Index). Patients at intermediate or high risk may require further assessment with a second-line test -- elastography, or a serum marker test with direct measures of fibrogenesis.

  • Because NAFLD is not an isolated disease but a component of cardiometabolic abnormalities typically associated with obesity, insulin resistance and type 2 diabetes, the cornerstone of therapy is lifestyle-based therapies (altered diet, such as reduced-calorie or Mediterranean diet and regular, moderate physical activity), and replacing obesogenic medications to decrease body weight and improve cardiometabolic health. Patients with diabetes who also have NASH may benefit from certain antidiabetic medications (i.e, pioglitazone, semaglutide) that treat not only their diabetes, but also reverse steatohepatitis and improve cardiometabolic health.

  • Optimal care of patients with NAFLD and NASH requires collaboration among primary care providers, endocrinologists, diabetologists, obesity medicine specialists, gastroenterologists and hepatologists, to tackle both the liver manifestations of the disease and the comorbid metabolic syndrome and cardiovascular risk, as well as screening and treating other comorbid conditions (e.g., obstructive sleep apnea).

NAFLD is one of the most common causes of liver disease, affecting over 25% of the population globally, and more than 60% of patients with type 2 diabetes. While NASH -- a more severe form of nonalcoholic fatty liver disease -- is less common, it is estimated to impact 4.9 million to 21 million Americans and more than 100 million individuals worldwide. NAFLD and NASH are thought of as "silent diseases," meaning they have few or no symptoms. If they go untreated and worsen, patients may experience severe liver damage and require liver transplantation. Catching NAFLD and NASH early can help manage the disease and prevent complications. Learn more.

Read the special report: Preparing for the NASH Epidemic: A Call to Action.

To learn more about the development of this publication, visit


Media contacts:

Courtney Reed,, American Gastroenterological Association

Chanel Carrington,, The Obesity Society

Cristos Mantzoros,, Endocrine Society

Heather Norton,, American Diabetes Association

About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization.

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About The Obesity Society

The Obesity Society (TOS) is the leading organization of scientists and health professionals devoted to understanding and reversing the epidemic of obesity and its adverse health, economic and societal effects. Combining the perspective of researchers, clinicians, policymakers and patients, TOS promotes innovative research, education and evidence-based clinical care to improve the health and well-being of all people with obesity. For more information, visit

About the American Diabetes Association

Every day more than 4,000 people are newly diagnosed with diabetes in America. More than 122 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the nation's leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For 80 years the ADA has been driving discovery and research to treat, manage and prevent diabetes, while working relentlessly for a cure. We help people with diabetes thrive by fighting for their rights and developing programs, advocacy and education designed to improve their quality of life. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association, Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).

About Gastroenterology

Gastroenterology is the most prominent journal in the field of gastrointestinal disease. As the official journal of the AGA Institute, Gastroenterology delivers up-to-date and authoritative coverage of both basic and clinical gastroenterology. Regular features include articles by leading authorities and reports on the latest treatments for diseases. Original research is organized by clinical and basic-translational content, as well as by alimentary tract, liver, pancreas, and biliary content.

About Obesity

Obesity is the official journal of The Obesity Society and is the premier source of information for increasing knowledge, fostering translational research from basic to population science, and promoting better treatment for people with obesity. With an Impact Factor of 5.002, Obesity publishes important peer-reviewed research and cutting-edge reviews, commentaries, and public health and medical developments.

About Metabolism: Clinical and Experimental

Metabolism (Editor-in-Chief Christos S. Mantzoros, MD, DSc, PhD h.c. mult) promotes excellence in research by publishing high-quality original research papers, fast-tracking cutting-edge papers, research brief reports, mini-reviews, and other special articles related to all aspects of human metabolism.

About Diabetes Care

Diabetes Care, a monthly journal of the American Diabetes Association (ADA), is the highest-ranked, peer-reviewed journal in the field of diabetes treatment and prevention research. Dedicated to increasing knowledge, stimulating research and promoting better health care for people with diabetes, the journal publishes original research on human studies in clinical care, education and nutrition; epidemiology, health services and psychosocial research; emerging treatments and technologies; and pathophysiology and complications. Diabetes Care also publishes the ADA's recommendations and statements, clinically relevant review articles, editorials and commentaries. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes care and education specialists and other health care professionals. Access Diabetes Care at and follow on Facebook (ADA Journals) and Twitter (@ADA_Journals).

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