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Liver biopsy is the gold standard applied to detect NASH and determine the stage of fibrosis, but its use is limited. There is a need for non\u2010invasive testing (NIT) techniques to identify patients considered at\u2010risk NASH (NASH with NAFLD activity score\u2009&gt;\u20094 and\u2009\u2265\u2009F2 fibrosis). For NAFLD\u2010associated fibrosis, several wet (serological) and dry (imaging) NITs are available and demonstrate a high negative predictive value (NPV) for excluding those with advanced hepatic fibrosis. However, identifying at\u2010risk NASH is more challenging; there is little guidance on how to use available NITs for these purposes, and these NITs are not specifically designed to identify at\u2010risk NASH patients. This review discusses the need for NITs in NAFLD and NASH and provides data to support the use of NITs, focusing on newer methods to non\u2010invasively identify at\u2010risk NASH patients. This review concludes with an algorithm that serves as an example of how NITs can be integrated into care pathways of patients with suspected NAFLD and potential NASH. This algorithm can be used for staging, risk stratification and the effective transition of patients who may benefit from specialty care.<\/jats:p>","DOI":"10.1111\/liv.15555","type":"journal-article","created":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T00:44:27Z","timestamp":1677804267000},"page":"964-974","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["The use of current knowledge and non\u2010invasive testing modalities for predicting at\u2010risk non\u2010alcoholic steatohepatitis and assessing fibrosis"],"prefix":"10.1111","volume":"43","author":[{"given":"Marcelo","family":"Kugelmas","sequence":"first","affiliation":[{"name":"South Denver Gastroenterology  Englewood Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen","family":"Noureddin","sequence":"additional","affiliation":[{"name":"Houston Research Institute  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadege","family":"Gunn","sequence":"additional","affiliation":[{"name":"Impact Research Institute  Waco Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Brown","sequence":"additional","affiliation":[{"name":"Henry Ford Hospital  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9313-577X","authenticated-orcid":false,"given":"Zobair","family":"Younossi","sequence":"additional","affiliation":[{"name":"Inova Fairfax Medical Campus  Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Abdelmalek","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naim","family":"Alkhouri","sequence":"additional","affiliation":[{"name":"Arizona Liver Health  Chandler Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29367"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.02.034"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28431"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32499"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2015.01.012"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1618"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0178473"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-015-9679-0"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28677"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41395-018-0088-6"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.11.039"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15830"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.22514"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29085"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27368"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000484"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-009-0008-4"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.07.027"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2029349"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24268"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30664"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20701"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.12565"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.01.038"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1473"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-019-0144-8"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.04.014"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-021-07089-w"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.03.084"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.04.043"},{"key":"e_1_2_10_32_1","unstructured":"NAFLD score. 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