Proposed algorithm to screen patients with type 2 diabetes for NAFLD
Patients with type 2 diabetes and suspected NAFLD can be risk-stratified using a combination of noninvasive scores/imaging. Indeterminate- and High-risk patients can then be prioritized for specialty referral for further investigation. 1Cut-off values reported by Angulo et al. . NFS is calculated using the formula: NFS = −1.675 + 0.037 – age (years) + 0.094 – BMI (kg/m2) + 1.13 × IFG/diabetes (yes = 1, no = 0) + 0.99 × AST/ALT ratio – 0.013 × platelet count (×109/l) – 0.66 × albumin (g/dl). (https://nafldscore.com/). FIB-4 is calculated using the formula: FIB-4 = Age (years)×AST (U/L)/[PLT(109/L)×ALT1/2 (U/L)] (https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4). 2Cut-off values reported by Tapper et al. . 3Rosenberg et al. . Abbreviations: T2D, type 2 diabetes; NAFLD, nonalcoholic fatty liver disease; US, ultrasonography; ALT, alanine aminotransferase; FIB-4, fibrosis index-4; NFS, NAFLD fibrosis score; VCTE, vibration-controlled transient elastography; ELF, enhanced liver fibrosis; MRE, magnetic resonance elastography; HCC, hepatocellular carcinoma; FDA, US food and drug administration.