{
  "society": "AASLD",
  "version": "2023",
  "publication_date": "2023-05-01",
  "title": "AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease",
  "status": "published",
  "recommendations": [
    {
      "recommendation_id": "AASLD-2023-R01",
      "topic": "definition",
      "text_en": "Use the term NAFLD (nonalcoholic fatty liver disease) for hepatic steatosis in absence of significant alcohol intake or other causes.",
      "text_kr_summary": "비음주 지방간을 NAFLD로 정의한다.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["28714183"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2023-R02",
      "topic": "screening",
      "text_en": "Patients with type 2 diabetes, obesity, or metabolic syndrome should be screened for NAFLD using FIB-4.",
      "text_kr_summary": "T2DM, 비만, 대사증후군 환자에서 FIB-4로 NAFLD 선별검사 시행.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["33271056", "31430416"],
      "related_nits": ["FIB-4"],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2023-R03",
      "topic": "fib4_cutoff",
      "text_en": "FIB-4 < 1.3 indicates low risk of advanced fibrosis; FIB-4 > 2.67 indicates high risk and needs specialist referral.",
      "text_kr_summary": "FIB-4 < 1.3 저위험, > 2.67 고위험.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["17326139"],
      "related_nits": ["FIB-4"],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2023-R04",
      "topic": "lsm_cutoff",
      "text_en": "Liver stiffness measurement (LSM) by VCTE: < 8 kPa rule out advanced fibrosis; > 12 kPa rule in.",
      "text_kr_summary": "LSM < 8 kPa 진행 섬유화 배제, > 12 kPa 진행 섬유화 시사.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["32492532"],
      "related_nits": ["LSM"],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2023-R05",
      "topic": "biopsy",
      "text_en": "Liver biopsy remains gold standard for diagnosing NASH and staging fibrosis when noninvasive tests are indeterminate.",
      "text_kr_summary": "NIT 불확실 시 간생검이 표준.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["29222917"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2023-R06",
      "topic": "weight_loss",
      "text_en": "Weight loss of 7-10% via lifestyle modification can lead to NASH resolution and fibrosis improvement.",
      "text_kr_summary": "체중감소 7-10%로 NASH 호전.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["25865049"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2023-R07",
      "topic": "pioglitazone",
      "text_en": "Pioglitazone may be considered in biopsy-proven NASH with or without diabetes.",
      "text_kr_summary": "조직검사 확진 NASH에 피오글리타존 고려 가능.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["27322798"],
      "related_nits": [],
      "related_drugs": ["pioglitazone"]
    },
    {
      "recommendation_id": "AASLD-2023-R08",
      "topic": "vitamin_e",
      "text_en": "Vitamin E 800 IU/day may be considered in non-diabetic adults with biopsy-proven NASH.",
      "text_kr_summary": "비당뇨 NASH 성인 비타민 E 고려.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["20218622"],
      "related_nits": [],
      "related_drugs": ["vitamin_e"]
    },
    {
      "recommendation_id": "AASLD-2023-R09",
      "topic": "glp1",
      "text_en": "GLP-1 receptor agonists (semaglutide) may be considered for obesity/T2DM patients with NAFLD given metabolic benefits.",
      "text_kr_summary": "비만/T2DM 동반 NAFLD에 GLP-1 RA 고려.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["33185364"],
      "related_nits": [],
      "related_drugs": ["semaglutide"]
    },
    {
      "recommendation_id": "AASLD-2023-R10",
      "topic": "monitoring",
      "text_en": "Patients with NAFLD should undergo periodic noninvasive fibrosis assessment every 1-3 years based on risk.",
      "text_kr_summary": "NAFLD 환자 위험도별 1-3년마다 NIT 재평가.",
      "strength": "conditional",
      "evidence_grade": "C",
      "cite_pmids": ["33340572"],
      "related_nits": ["FIB-4", "LSM"],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2023-R11",
      "topic": "hcc_screening",
      "text_en": "HCC surveillance should be performed in NAFLD cirrhosis with biannual ultrasound +/- AFP.",
      "text_kr_summary": "NAFLD 간경변에서 6개월마다 초음파+/-AFP HCC 감시.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["29624699"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "AASLD-2023-R12",
      "topic": "fast_score",
      "text_en": "FAST score < 0.35 rules out at-risk NASH; > 0.67 rules in.",
      "text_kr_summary": "FAST < 0.35 배제, > 0.67 확진.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["32178492"],
      "related_nits": ["FAST"],
      "related_drugs": []
    }
  ]
}