**5. Screening for NAFLD and NASH**

Identification of pre-symptomatic individuals or patients at risk would be the best to enable earlier disease intervention and management. There is a large number of early signs or symptoms indicating the onset of NAFLD, including central obesity, elevated serum triglyceride, and impaired fasting glucose. In addition, anorexia, nausea, vomiting, malaise, headache, or even epigastric and right upper quadrant abdominal pain, mild jaundice, and thrombocytopenia can already hint to initiation of NAFLD. Therefore, it was proposed that the potential of simple steatosis to progress into severe NAFLD necessitates timely detection of risk stratification in community-based healthcare settings [139]. However, despite multiple research reports demonstrating amazing promises, most of the proposed early protein or nucleic acid biomarkers are presently characterized by low sensitivity, low stability, and limited specificity [139]. In addition, screening programs, analyzing diagnostic panels are costly. Last but not least, NAFLD may be less benign than currently thought [33]. Therefore, there are limitations in defining diagnostic starting points for the management of prodomic phases of NAFLD. This is potentially the reason, why Scientific Societies such as the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of Liver Diseases (EASL), the National Institute for Health and Care Excellence (NICE), and the Asia-Pacific Working Party do not support a NAFLD screening program or only recommend screening programs in high-risk groups [140].
