Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease

Kanwal, Fasiha; Shubrook, Jay H.; Adams, Leon A.; Pfotenhauer, Kim; Wong, Vincent Wai‐Sun; Wright, Eugene; Abdelmalek, Manal F.; Harrison, Stephen A.; Loomba, Rohit; Mantzoros, Christos S.; Bugianesi, Elisabetta; Eckel, Robert H.; Kaplan, Lee M.; El–Serag, Hashem B.; Cusi, Kenneth

doi:10.1053/j.gastro.2021.07.049

Cited by 338 publications

(428 citation statements)

References 108 publications

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“…[ 76 ] Recently, the American Gastroenterological Association, in collaboration with members from other professional societies, proposed a clinical care pathway for NAFLD [Figure 1 ]. [ 102 ] Compared with similar algorithms, this pathway adopted opinions from primary care physicians and recommends FIB-4 instead of abdominal ultrasonography as the initial assessment, as blood tests are often more accessible than imaging in primary care settings.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive tests of non-alcoholic fatty liver disease

Zhang

Lin

et al. 2022

Chinese Medical Journal

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For the detection of steatosis, quantitative ultrasound imaging techniques have achieved great progress in past years. Magnetic resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic steatosis. Some blood biomarkers correlate with non-alcoholic steatohepatitis, but the accuracy is modest. Regarding liver fibrosis, liver stiffness measurement by transient elastography (TE) has high accuracy and is widely used across the world. Magnetic resonance elastography is marginally better than TE but is limited by its cost and availability. Several blood biomarkers of fibrosis have been used in clinical trials and hold promise for selecting patients for treatment and monitoring treatment response. This article reviews new developments in the non-invasive assessment of non-alcoholic fatty liver disease (NAFLD). Accumulating evidence suggests that various non-invasive tests can be used to diagnose NAFLD, assess its severity, and predict the prognosis. Further studies are needed to determine the role of the tests as monitoring tools. We cannot overemphasize the importance of context in selecting appropriate tests.

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Section: Discussionmentioning

confidence: 99%

Non-invasive tests of non-alcoholic fatty liver disease

Zhang

Lin

et al. 2022

Chinese Medical Journal

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“…As proposed by the clinical care pathway from the American Gastroenterology Association (AGA), the first biochemical evidence alluding to a diagnosis of Non-Alcoholic Fatty Liver Disease (NAFLD) is the abnormal serum liver biochemistry [ 29 ].…”

Section: Biochemical Diagnostic Markersmentioning

confidence: 99%

“…Even though the majority of patients with NAFLD and NASH are asymptomatic, a mild elevation of liver function tests (usually less than five times the upper limit of normal) might be observed [ 29 ]. It is important to highlight that the degree of aminotransferase rise does not reflect the degree of hepatocellular injury associated with NAFLD/NASH [ 30 ].…”

Section: Biochemical Diagnostic Markersmentioning

confidence: 99%

“…Over the last two decades, there has been significant development in the evaluation of NAFLD by non-invasive imaging, and novel techniques with high accuracy are now widely available [ 132 ]. According to the recently developed clinical care pathway by the American Gastroenterological Association (AGA), imaging modalities in combination with biochemical indices for NAFLD offer significant improvements in the diagnosis of NAFLD and screening for advanced fibrosis [ 29 ]. In this section, we discuss the various non-invasive modalities being available for the diagnosis of NAFLD, as well as their advantages and limitations.…”

Section: Imaging Biomarkersmentioning

confidence: 99%

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Diagnostic Modalities of Non-Alcoholic Fatty Liver Disease: From Biochemical Biomarkers to Multi-Omics Non-Invasive Approaches

et al. 2022

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Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the most common cause of chronic liver disease worldwide, and its prevalence is increasing globally. NAFLD is a multifaceted disorder, and its spectrum includes steatosis to steatohepatitis, which may evolve to advanced fibrosis and cirrhosis. In addition, the presence of NAFLD is independently associated with a higher cardiometabolic risk and increased mortality rates. Considering that the vast majority of individuals with NAFLD are mainly asymptomatic, early diagnosis of non-alcoholic steatohepatitis (NASH) and accurate staging of fibrosis risk is crucial for better stratification, monitoring and targeted management of patients at risk. To date, liver biopsy remains the gold standard procedure for the diagnosis of NASH and staging of NAFLD. However, due to its invasive nature, research on non-invasive tests is rapidly increasing with significant advances having been achieved during the last decades in the diagnostic field. New promising non-invasive biomarkers and techniques have been developed, evaluated and assessed, including biochemical markers, imaging modalities and the most recent multi-omics approaches. Our article provides a comprehensive review of the currently available and emerging non-invasive diagnostic tools used in assessing NAFLD, also highlighting the importance of accurate and validated diagnostic tools.

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“…Cut-offs: Enhanced Liver Fibrosis (ELF™ test) 9.8; Fiobrotest 0.48; FibroMeter 0.45. Adapted based on references [ 127 , 128 , 142 , 143 , 144 ].…”

Section: Figurementioning

confidence: 99%

Hepatocellular Carcinoma in Non-Alcoholic Fatty Liver Disease: From Epidemiology to Diagnostic Approach

Grgurević

Božin

Mikuš

et al. 2021

Cancers

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Non-alcoholic fatty liver disease (NAFLD) is becoming the leading cause of liver morbidity worldwide and, as such, represents the pathogenic background for the increasing incidence of hepatocellular carcinoma (HCC). The annual incidence of NAFLD-related HCC is expected to increase by 45–130% by 2030. Diabetes mellitus is the most important risk factor for HCC development in NAFLD, with the risk further increased when associated with other metabolic traits, such as obesity, arterial hypertension and dyslipidemia. The highest risk of HCC exists in patients with advanced fibrosis or cirrhosis, although 20–50% of HCC cases arise in NAFLD patients with an absence of cirrhosis. This calls for further investigation of the pathogenic mechanisms that are involved in hepatocarcinogenesis, including genetics, metabolomics, the influence of the gut microbiota and immunological responses. Early identification of patients with or at risk of NAFLD is of utmost importance to improve outcomes. As NAFLD is highly prevalent in the community, the identification of cases should rely upon simple demographic and clinical characteristics. Once identified, these patients should then be evaluated for the presence of advanced fibrosis or cirrhosis and subsequently enter HCC surveillance programs if appropriate. A significant problem is the early recognition of non-cirrhotic NAFLD patients who will develop HCC, where new biomarkers and scores are potential solutions to tackle this issue.

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Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease

Cited by 338 publications

References 108 publications

Non-invasive tests of non-alcoholic fatty liver disease

Non-invasive tests of non-alcoholic fatty liver disease

Diagnostic Modalities of Non-Alcoholic Fatty Liver Disease: From Biochemical Biomarkers to Multi-Omics Non-Invasive Approaches

Hepatocellular Carcinoma in Non-Alcoholic Fatty Liver Disease: From Epidemiology to Diagnostic Approach

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