Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance

Glen, J. B.; Floros, Lefteris; Day, Chris; Pryke, Rachel

doi:10.1136/bmj.i4428

Cited by 167 publications

(180 citation statements)

References 10 publications

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“…However, it is reasonable to hypothesize that AF was likely to be under‐diagnosed since a significant proportion of patients with NAFLD could have paroxysmal AF that has yet to be diagnosed. Finally, another potential limitation of the meta‐analysis is that most of the eligible studies used liver ultrasonography, which is the recommended first‐line imaging method for diagnosing NAFLD in clinical practice, whereas only a hospital‐based cohort study used liver biopsy, which is the reference method for diagnosing and staging NAFLD . That said, future studies in larger cohorts of well‐characterized patients with NAFLD (as diagnosed by magnetic resonance‐proton density fat fraction and magnetic resonance elastography, which are rapidly being recognized as being as good as liver biopsies) are needed to clarify whether the severity of NAFLD may differentially affect risk of developing AF …”

Section: Discussionmentioning

confidence: 99%

Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

Mantovani

Dauriz

Sandri

et al. 2019

Liver International

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Background & Aims Recent studies examined the association between non‐alcoholic fatty liver disease (NAFLD) and risk of atrial fibrillation (AF) in adults, but the findings have been inconsistent. We provided a quantitative estimate of the magnitude of the association between NAFLD and risk of AF. Methods We searched publication databases using predefined keywords to identify observational studies (published up to December 14, 2018), in which NAFLD was diagnosed by biopsy, imaging or biochemistry and AF was diagnosed by medical history and electrocardiograms. Data from selected studies were extracted and meta‐analysis was performed using random‐effects modelling. Results Nine cross‐sectional and longitudinal studies were included in the final analysis (n = 364 919 individuals). Meta‐analysis of data from 5 cross‐sectional studies showed that NAFLD was associated with an increased risk of prevalent AF (random‐effects odds ratio 2.07, 95% CI 1.38‐3.10; I2 = 54.7%), independent of age, sex, body mass index, hypertension and other common AF risk factors. This risk was particularly high among patients with established diabetes (n = 1 study; random‐effects odds ratio 5.17, 95% CI 2.05‐13.02). Meta‐analysis of data from 4 longitudinal studies showed that NAFLD was independently associated with a 10‐year increased risk of incident AF only in type 2 diabetic patients (n = 1 study; random‐effects hazard ratio 4.96, 95% CI 1.42‐17.28). Sensitivity analyses did not modify these findings. Funnel plots did not reveal significant publication bias. Conclusions NAFLD is associated with an increased risk of AF in middle‐aged and elderly individuals (especially in those with type 2 diabetes). However, the observational design of the eligible studies does not allow for proving causality.

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Section: Discussionmentioning

confidence: 99%

Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

Mantovani

Dauriz

Sandri

et al. 2019

Liver International

View full text Add to dashboard Cite

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“…However, we believe that more detailed analyses of the causes of heterogeneity will require collaborative pooling of individual participant data from large prospective studies, when these will become available in the future. Finally, another potential limitation of this meta‐analysis is that most studies used liver ultrasonography, which is the recommended first‐line imaging method for diagnosing NAFLD in clinical practice, whereas only one study used biopsy, which is the reference method for diagnosing and staging NAFLD …”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

Mantovani

Dauriz

Gatti

et al. 2019

Aliment Pharmacol Ther

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Summary Background Several studies have explored the effect of non‐alcoholic fatty liver disease (NAFLD) on bone mineral density (BMD) and risk of osteoporotic fractures in adults. However, the extent to which NAFLD adversely affects bone health remains uncertain. Aim To provide a quantitative estimation of the magnitude of the association of NAFLD with BMD or history of osteoporotic fractures in adults. Methods We searched PubMed, Web of Science, and Scopus using predefined keywords to identify all observational studies, published up to 31 August 2018, in which NAFLD was diagnosed by imaging or histology; BMD was measured by dual energy X‐ray absorptiometry; and a self‐reported history of osteoporotic fractures was collected with interviewer‐assisted questionnaires. Data from selected studies were extracted, and meta‐analysis was performed using random‐effects modelling. Results Twelve cross‐sectional or case‐control studies with aggregate data on 30 041 adults of predominantly Asian ethnicity (30% with NAFLD) were included in the final analysis. No significant differences in BMD at different skeletal sites (whole body, lumbar spine, or femur) were observed between individuals with and without NAFLD. Conversely, NAFLD was associated with increased odds of osteoporotic fractures, especially in older Chinese men (n = 2 studies; random‐effects odds ratio 2.10, 95% CI 1.36‐3.25; I2 = 0%). Sensitivity analyses did not alter these findings. The funnel plot and Egger test did not reveal significant publication bias. Conclusions This meta‐analysis suggests that imaging‐defined or biopsy‐proven NAFLD is associated with a self‐reported history of osteoporotic fractures (principally in Chinese men), but not with low BMD, in middle‐aged and elderly individuals.

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“…The ELF test is a commercial panel of markers (tissue inhibitor of matrix metalloproteinase, hyaluronic acid, and the aminoterminal peptide of procollagen III) focusing on matrix turnover that has good diagnostic accuracy for advanced fibrosis in NAFLD . In contrast to the European associations, the United Kingdom National Institute for Health and Care Excellence (NICE) guidelines on the assessment and management of NAFLD recommend using the ELF test as the first‐line test for advanced fibrosis in people who have been diagnosed with NAFLD . Both guidelines recommend that if significant fibrosis cannot be ruled out, patients should be referred to a liver clinic for further evaluation, including liver stiffness measurements (LSMs).…”

mentioning

confidence: 99%

A Pragmatic Approach Identifies a High Rate of Nonalcoholic Fatty Liver Disease With Advanced Fibrosis in Diabetes Clinics and At‐Risk Populations in Primary Care

Patel

Hossain

Horsfall

et al. 2018

Hepatology Communications

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Noninvasive serum biomarkers (nonalcoholic fatty liver disease fibrosis score [NFS], fibrosis 4 score [FIB‐4], or enhanced liver fibrosis [ELF] test) are recommended as first‐line tools to determine the risk of advanced fibrosis in nonalcoholic fatty liver disease. We aimed to assess the utility of a pragmatic approach to screening for clinically significant fibrosis in primary care and diabetes clinics. We recruited 252 patients from an endocrine clinic or primary care facility. Anthropometric measurements, ELF test, ultrasound, and liver stiffness measurements (LSMs) were performed. Clinically significant fibrosis was defined as LSM ≥8.2 kPa or ELF ≥9.8. A subgroup of patients underwent liver biopsy (n = 48) or had imaging diagnostic of cirrhosis (n = 14). Patients were 57.3 ± 12.3 years old with a high prevalence of metabolic syndrome (84.5%), type 2 diabetes (82.5%), and body mass index (BMI) ≥40 kg/m2 (21.8%). LSM met quality criteria in 230 (91.3%) patients. NFS and FIB‐4 combined had a high negative predictive value (90.0%) for excluding LSM ≥8.2 kPa. However, 84.1% of patients had indeterminate or high NFS or FIB‐4 scores requiring further assessment. LSM ≥8.2 kPa and ELF ≥9.8 were present in 31.3% and 28.6% of patients, respectively. Following adjustment for age, BMI, sex, and presence of advanced fibrosis, older age was independently associated with ELF ≥9.8 (adjusted odds ratio, 1.14; 95% confidence interval, 1.06‐1.24), whereas increasing BMI was independently associated with LSM ≥8.2 kPa (adjusted odds ratio, 1.15; 95% confidence interval, 1.01‐1.30). Concordant LSM <8.2 kPa and ELF <9.8 and concordant LSM ≥8.2 kPa and ELF ≥9.8 had a high negative predictive value (91.7%) and positive predictive value (95.8%) for excluding and identifying clinically significant fibrosis, respectively. Conclusion: Simple scoring tools alone lack accuracy. LSM accuracy is influenced by severe obesity, whereas age impacts the ELF test. Further studies are required to confirm whether combining LSM and ELF may enhance accuracy and confidence in identifying clinically significant fibrosis. (Hepatology Communications 2018; 00:000‐000)

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Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance

Cited by 167 publications

References 10 publications

Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

A Pragmatic Approach Identifies a High Rate of Nonalcoholic Fatty Liver Disease With Advanced Fibrosis in Diabetes Clinics and At‐Risk Populations in Primary Care

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