Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods

doi:10.1007/s00535-017-1414-2

Review

. 2018 Feb;53(2):181-196.

doi: 10.1007/s00535-017-1414-2. Epub 2017 Nov 24.

Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods

Affiliations

¹ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
² Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
³ Liver Center, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
⁴ Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
⁵ General Internal Medicine 2, General Medical Center, Kawasaki Medical School, 2-6-1 Nakasange, Kutaku, Okayama, 700-8505, Japan.
⁶ Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
⁷ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. nakajima-tky@umin.ac.jp.

PMID: 29177681
PMCID: PMC5846871
DOI: 10.1007/s00535-017-1414-2

Review

Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods

Masato Yoneda et al. J Gastroenterol. 2018 Feb.

. 2018 Feb;53(2):181-196.

doi: 10.1007/s00535-017-1414-2. Epub 2017 Nov 24.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
² Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
³ Liver Center, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
⁴ Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
⁵ General Internal Medicine 2, General Medical Center, Kawasaki Medical School, 2-6-1 Nakasange, Kutaku, Okayama, 700-8505, Japan.
⁶ Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
⁷ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. nakajima-tky@umin.ac.jp.

PMID: 29177681
PMCID: PMC5846871
DOI: 10.1007/s00535-017-1414-2

Abstract

Nonalcoholic fatty liver disease (NAFLD) is an important cause of chronic liver injury in many countries. The incidence of NAFLD is rising rapidly in both adults and children, because of the currently ongoing epidemics of obesity and type 2 diabetes. Notably, histological liver fibrosis is recognized as the main predictive factor for the overall long-term outcome of NAFLD, including cardiovascular disease and liver-related mortality. Thus, staging of liver fibrosis is essential in determining the prognosis and optimal treatment for patients with NAFLD and in guiding surveillance for the development of hepatocellular carcinoma (HCC). Whereas liver biopsy remains the gold standard for staging liver fibrosis, it is impossible to enforce liver biopsy in all patients with NAFLD. Noninvasive biological markers, scoring systems and noninvasive modalities are increasingly being developed and investigated to evaluate fibrosis stage of NAFLD patients. This review will highlight recent studies on the diagnosis and staging of NAFLD based on invasive (liver biopsy) or noninvasive (biomarker, scoring systems, US-based elastography and MR elastography) methods.

Keywords: Elastography; Liver biopsy; MR elastography; Nonalcoholic fatty liver disease; Scoring system.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
Noninvasive biomarkers for the diagnosis of nonalcoholic steatohepatitis. Fuc-Hpt Fucosylated haptoglobin, *CK18* cytokeratin-18 fragment, *TNFα* tumor necrosis factor-α, *DHEA-S* dehydroepiandrosterone sulfate, *IGF-1* insulin-like growth factor-1, FT free testosterone, *sLOX-1* oxidized low-density lipoprotein receptor-1, *AGEs* advanced glycation end products, *HOMA-IR* homeostasis model assessment-insulin resistance, *WFA+ -M2BP* wisteria floribunda agglutinin mac-2-binding protein

**Fig. 2**
Clinical algorithm for diagnosing and following the patients with NAFLD based on liver biopsy and noninvasive methods. Solid arrow: recommended flow with consensus. Dotted arrow: recommended flow

See this image and copyright information in PMC

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References

1. Day CP. Non-alcoholic steatohepatitis (NASH): where are we now and where are we going? Gut. 2002;50:585–588. - PMC - PubMed
1. Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008;28:339–350. - PubMed
1. Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61:1547–1554. - PubMed
1. Day CP, Saksena S. Non-alcoholic steatohepatitis: definitions and pathogenesis. J Gastroenterol Hepatol. 2002;17(Suppl 3):S377–S384. - PubMed
1. Harrison SA, Torgerson S, Hayashi PH. The natural history of nonalcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol. 2003;98:2042–2047. - PubMed

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[1] Day CP. Non-alcoholic steatohepatitis (NASH): where are we now and where are we going? Gut. 2002;50:585–588. - PMC - PubMed

[2] Day CP. Non-alcoholic steatohepatitis (NASH): where are we now and where are we going? Gut. 2002;50:585–588. - PMC - PubMed

[3] Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008;28:339–350. - PubMed

[4] Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008;28:339–350. - PubMed

[5] Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61:1547–1554. - PubMed

[6] Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61:1547–1554. - PubMed

[7] Day CP, Saksena S. Non-alcoholic steatohepatitis: definitions and pathogenesis. J Gastroenterol Hepatol. 2002;17(Suppl 3):S377–S384. - PubMed

[8] Day CP, Saksena S. Non-alcoholic steatohepatitis: definitions and pathogenesis. J Gastroenterol Hepatol. 2002;17(Suppl 3):S377–S384. - PubMed

[9] Harrison SA, Torgerson S, Hayashi PH. The natural history of nonalcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol. 2003;98:2042–2047. - PubMed

[10] Harrison SA, Torgerson S, Hayashi PH. The natural history of nonalcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol. 2003;98:2042–2047. - PubMed

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Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods

Affiliations

Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods

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Abstract

Conflict of interest statement

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