Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2021; 27(35): 5803-5821
Published online Sep 21, 2021. doi: 10.3748/wjg.v27.i35.5803
Screening for nonalcoholic fatty liver disease-when, who and how?
Christoph G Dietrich, Monika Rau, Andreas Geier
Christoph G Dietrich, Department of Internal Medicine, Bethlehem Health Center, Stolberg 52222, Germany
Monika Rau, Department of Internal Medicine II, University Hospital Würzburg, Würzburg 97080, Germany
Andreas Geier, Department of Medicine II, University Hospital Würzburg, Würzburg 97080, Germany
Author contributions: Dietrich CG and Geier A developed the concept of this review; all authors contributed to the manuscript.
Conflict-of-interest statement: CGD reports personal speaker fees from Falk Foundation. MR declares no conflict of interest. AG serves as advisor and steering committee member for AbbVie, Alexion, Bayer, BMS, CSL Behring, Eisai, Gilead, Intercept, Ipsen, Merz, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, Sequana and as speaker for AbbVie, Alexion, BMS, CSL Behring, Falk, Gilead, Intercept, Merz, MSD, Novartis, Roche, Sequana. AG also received research support from Intercept and Falk (NAFLD CSG), Novartis.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christoph G Dietrich, MD, PhD, Chief Doctor, Department of Internal Medicine, Bethlehem Health Center, Steinfeldstr. 5, Stolberg 52222, Germany. christoph.g.dietrich@googlemail.com
Received: March 16, 2021
Peer-review started: March 16, 2021
First decision: May 1, 2021
Revised: May 13, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: September 21, 2021

Nonalcoholic fatty liver disease (NAFLD) is becoming a frequent liver disease, especially in patients with metabolic syndrome and especially in Western countries. Complications of NAFLD comprise progressive fibrosis, cirrhosis and hepatocellular carcinoma. NAFLD also represents an independent risk factor for cardiovascular disease, extrahepatic neoplasia and other organ damage, such as renal insufficiency. Given the epidemiological importance of the disease, new developments in specific treatment of the disease and the wide availability of noninvasive techniques in estimating steatosis and fibrosis, NAFLD should be subject to screening programs, at least in countries with a high prevalence of the disease. The review discusses prerequisites for screening, cost-effectiveness, current guideline recommendations, suitability of techniques for screening and propositions for the following questions: Who should be screened? Who should perform screening? How should screening be performed? It is time for a screening program in patients at risk for NAFLD.

Keywords: Screening, Nonalcoholic fatty liver disease, Diabetes, Liver fibrosis, Cirrhosis

Core Tip: Nonalcoholic fatty liver disease (NAFLD) is becoming more important in Western countries and leads to serious complications in patients with progressive disease. The epidemiological, clinical and technical requirements for screening for this disease are fulfilled and are outlaid in this review. It is time to consider a screening program for NAFLD.