Review: Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 1: Definition, risk factors and assessment

Since the publication of the guidelines for the assessment and management of non alco-holic fatty liver disease (NAFLD) by the Asia–Pacific Working Party on NAFLD in 2007,1 our understanding of the clinical characteristics and natural history of NAFLD has improved, and there have been developments in the assessment and treatment of NAFLD. It is therefore timely to update the guidelines in light of new evidence.This document presents the recommendations of the Asia–Pacific Working Party on NAFLD. The exercise was supported by the Journal of Gastroenterology and Hepatology Foundation. Members performed a systematic review of the literature on specified domains of interest, thereby allowing them to provide recommendations on different aspects of the clinical assessment and management of patients with NAFLD. The contents and statements were then discussed through face-to-face meetings and e-mail communications. The statements in this document follow the Grading of Recommendation Assessment, Develop-ment, and Evaluation approach (Table 1).2 The final grading of evidence and recommenda-tions was determined by majority vote.These guidelines cover various aspects in the management of NAFLD, including diagno-sis, screening, assessment, and treatment. While most evidence came from studies on adults identified to be at risk of metabolic disorder and after exclusion of other liver diseases, two special populations are included in this document. NAFLD in children and adolescents is becoming increasingly prevalent and may have devastating consequences owing to the long duration of fatty liver disease. In addition, chronic viral hepatitis is highly prevalent in Asia–Pacific countries, and the impact of concomitant fatty liver, a much discussed topic both for hepatitis B and C, is re-evaluated here for its long-term clinical significance and implications for patient care