{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:00:24Z","timestamp":1783072824731,"version":"3.54.6"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T00:00:00Z","timestamp":1667520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n            <jats:title>Background and aims:<\/jats:title>\n            <jats:p>The American Gastroenterological Association (AGA) recently launched the Clinical Care Pathway for the Risk Stratification and Management of Patients with NAFLD to identify adults with significant fibrosis. We aimed to examine this pathway\u2019s performance in the US population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results:<\/jats:title>\n            <jats:p>Using the 2017\u20132018 National Health and Nutrition Examination Survey data, we identified participants aged \u226518 with available Fibrosis\u20104 (FIB\u20104) score and liver stiffness measurement (LSM) in the absence of other liver diseases. Based on the AGA clinical pathway, FIB\u20104\u2009&lt;\u20091.3 and LSM\u2009&lt;\u20098 kilopascals (kPa) by vibration\u2010controlled transient elastography (VCTE) are associated with low risk of significant fibrosis. Using these cutoffs, we examined the pathway performance using negative predictive value (NPV) and positive predictive value (PPV) and explored alternative risk\u2010stratification strategies. There were 2322 participants with available data (projected to 94.2 million US adults). The NPV of LSM\u2009\u2265\u20098 kPa among those with FIB\u20104\u2009&lt;\u20091.3 was 90%, whereas the PPV among those with FIB\u20104 1.3\u20132.67 was 13%. As diabetes was a strong predictor of fibrosis, we propose a simple, alternative strategy to eliminate the indeterminate FIB\u20104 range and perform VCTE in those with FIB\u20104\u2009\u2265\u20091.3 and diabetes. This strategy would decrease the number of VCTEs from 14.5 to 4.9 million and increase PPV from 13% to 33% without compromising the NPV among those who did not undergo VCTE.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>The implementation of the current AGA clinical pathway would lead to overutilization of VCTE. An alternative strategy using FIB\u20104\u2009\u2265\u20091.3 and diabetes to select adults undergoing second\u2010line testing will improve this pathway\u2019s performance and minimize unnecessary VCTEs.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.32739","type":"journal-article","created":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T01:44:20Z","timestamp":1661132660000},"page":"931-941","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":36,"title":["Performance of American Gastroenterological Association Clinical Care Pathway for the risk stratification of patients with nonalcoholic fatty liver disease in the US population"],"prefix":"10.1097","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1022-7615","authenticated-orcid":false,"given":"Prowpanga","family":"Udompap","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 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