Nonalcoholic fatty liver disease care at Mayo Clinic
Your Mayo Clinic care team
At Mayo Clinic, physicians specializing in digestive diseases (gastroenterologists) work with radiologists, pathologists, nurse practitioners and physician assistants to diagnose nonalcoholic fatty liver disease. Other specialists who may be part of your team include dietitians, weight-loss (bariatric) specialists and professional counselors to support lifestyle change.
Pediatric expertise
NAFLD can happen in children as well as adults. About 10% of U.S. children ages 2 to 19 have NAFLD. Pediatric hepatologists on staff at Mayo Clinic Children's Center and Mayo Eugenio Litta Children's Hospital at Mayo Clinic Hospital, Saint Marys Campus, in Rochester, Minnesota, have experience caring for young people with NAFLD at all stages, including end-stage liver disease requiring transplantation.
Weight-loss surgeons with pediatric expertise also are on staff at Mayo Clinic's campus in Rochester, Minnesota. If a liver transplant is necessary, transplant surgeons, transplant-focused hepatologists and nurses who coordinate the transplant program join the care team.
Benefits of collaboration
The multidisciplinary approach at Mayo Clinic lets you benefit from the knowledge and experience of each specialist on your care team. Team members collaborate closely in planning each person's care. This collaboration also means your appointments are coordinated and your test results are available quickly. Evaluation and treatment that might take months elsewhere can typically be done in only a matter of days at Mayo Clinic.
Advanced diagnosis and treatment
Diagnosing NAFLD and determining how much liver scarring there is can be difficult. This is partly because standard tests can't exactly measure the amount of liver damage. At Mayo Clinic, however, state-of-the-art imaging has made the diagnostic process simpler and more reliable than it was less than a decade ago.
Noninvasive techniques
Thanks to new liver imaging tests, many people being seen for possible NAFLD and NASH at Mayo Clinic can avoid liver biopsy. Mayo Clinic researchers developed one of these noninvasive techniques, magnetic resonance elastography (MRE), which measures liver damage more accurately than other kinds of imaging tests.
Mayo Clinic hepatologists and transplant surgeons also have helped improve care for people with obesity, NASH and end-stage liver disease requiring transplantation.
When possible, these patients can join an intensive weight management program before and after their liver transplant. Because of these programs, Mayo Clinic can offer liver transplant to certain people with severe obesity. Those unable to lose the recommended amount of weight before transplant surgery may have combined obesity and transplant surgery.
In some situations, weight-loss surgery may be helpful. Mayo Clinic also offers less-invasive alternatives to gastric bypass and other open weight-loss procedures. These minimally invasive procedures — intragastric balloon insertion and endoscopic sleeve gastroplasty — have results similar to gastric bypass surgery, with a fraction of the recovery time and limited risk of scarring.
Magnetic resonance elastography
Richard L. Ehman, M.D., Diagnostic Radiology, Mayo Clinic: MR elastography is a technique for imaging the mechanical properties of tissue.
Vivien Williams: Dr. Richard Ehman invented the technology. It uses MRI and low-frequency mechanical vibrations and allows doctors to see the liver in a new way. It not only shows the structure of the liver, but it also shows the stiffness of the liver tissue. Other imaging techniques can't do that.
Dr. Ehman: The vibrations that we apply are not uncomfortable. And the risks associated with the exam would be those that would be associated with an MRI exam, which, in general, is a very safe procedure.
Vivien Williams: Here's how it works. A piece of equipment that looks like a little drum is placed on the patient's abdomen. The vibrations move through stiff tissue and supple tissue at different rates. A computer analyzes the differences and shows what's healthy soft tissue and what's not. What the doctor sees is a color-coded image called an elastogram.
Dr. Ehman: The red would correspond to cirrhosis.
Vivien Williams: MRE is noninvasive, and it gives a picture of the entire liver, not just a sampling of one area as is the case with biopsies.
Dr. Ehman: With a needle biopsy, we're taking a tiny, little thread of liver tissue and using that to represent the status of the whole liver. And you can see how, if we sampled one area that was, basically, normal, it might not detect disease in other parts of the liver.
Nonalcoholic steatohepatitis (NASH)
[MUSIC PLAYING]
Alina M. Allen, M.D., Gastroenterology & Hepatology, Mayo Clinic: So the liver is a complex organ. It has a lot of functions. Patients with nonalcoholic fatty liver disease benefit from the Mayo care because we offer the best technologies in a timely fashion.
Kymberly D. Watt, M.D., Gastroenterology & Hepatology, Mayo Clinic: The nonalcoholic part of that is actually very important because obviously there's an alcoholic version of fatty liver disease. And a lot of people all think every liver disease is alcohol related, and it is very, very wrong.
Harmeet Malhi, M.B.B.S., Gastroenterology & Hepatology, Mayo Clinic: NAFLD stands for nonalcoholic fatty liver disease. It really is an umbrella term for a continuum of diseases. And when we see additional features of inflammation and injury in the liver, we refer to that as nonalcoholic steatohepatitis, which is a mouthful. So just NASH.
Dr. Watt: Impact of NASH is huge actually and it is not only growing and prevalence, but I think it's also being recognized more. There's more obesity, diabetes, metabolic syndrome that lead to NASH.
Dr. Allen: Approximately 40% of the U.S. population is obese and fatty liver disease is a problem that comes in conjunction with this excess weight.
Dr. Malhi: How we diagnose nonalcoholic fatty liver disease. Really the gold standard has been a liver biopsy. However, liver biopsy is invasive, and Mayo has really been a pioneer in the development of a technique called magnetic resonance elastography or let's call it MRE for short, which helps us quantify or measure the amount of scarring or stiffness there is in the liver.
Dr. Allen: The good news is that if the diseases caught earlier, the diseases reversible because the liver is a forgiving organ.
Dr. Watt: If you can get the fat and the inflammation out of the liver, you could potentially at least delay progression. You might be able to have regression.
Dr. Allen: We make a personalized treatment plan. The plan starts with visiting with a nutritionist to discuss about what are the best ways to change the way they eat in order to lose weight.
Dr. Watt: We're trying to think long term and we need to be aggressive in managing all the issues.
[MUSIC PLAYING]
Expertise and rankings
Experience
Mayo Clinic doctors have expertise and experience in evaluating and caring for people who have NAFLD, treating more than 9,000 people every year for this chronic liver disorder.
Leaders in research
Mayo Clinic doctors were the first to identify nonalcoholic steatohepatitis, in a report published in 1980. In the years that followed, Mayo Clinic researchers have made unparalleled advances in both basic science and clinical care related to the disease.
Nationally recognized expertise
Mayo Clinic in Rochester, Minnesota, ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Phoenix/Scottsdale, Arizona, and Mayo Clinic in Jacksonville, Florida, are ranked among the Best Hospitals for digestive disorders by U.S. News & World Report. Mayo Clinic Children's Center in Rochester is ranked the No. 1 hospital in Minnesota, and the five-state region of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin, according to U.S. News & World Report's 2023–2024 "Best Children's Hospitals" rankings.
Locations, travel and lodging
Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of locations in several states.
For more information on visiting Mayo Clinic, choose your location below:
Costs and insurance
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people.
In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
Learn more about appointments at Mayo Clinic.
Please contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your visit. Often, your insurer's customer service number is printed on the back of your insurance card.