Systematic review of existing guidelines for NAFLD assessment

Abstract

Aim: In this systematic review, guidelines on non-alcoholic fatty liver disease (NAFLD) were evaluated, aiming at a guideline synthesis focusing on diagnosis and staging.Methods: A systematic literature search was conducted on any relevant database or institutional website to find guidelines on NAFLD assessment intended for clinical use on humans, in English, published from January 2010 to August 2020. Included guidelines were appraised using the AGREE II Instrument; those with higher scores and intended for use in adult patients were included in a comparative analysis.Results: Fourteen guidelines were included in the systematic review, eight of which reached an AGREE II score sufficiently high to be recommended for clinical use, of which one developed for pediatric patients only. British and North American guidelines received the highest scores. Most guidelines recommend a screening or case-finding approach in patients with metabolic risk factors who are at increased risk of steatohepatitis or fibrosis. Ultrasound is mostly recommended to confirm steatosis, while the presence of metabolic syndrome, liver function tests, fibrosis scores, and elastographic techniques may help in selecting high-risk patients to be referred to the hepatologist, who may consider liver biopsy, although referral criteria for liver biopsy are not clearly defined. Most guidelines identify the development of noninvasive tests to replace liver biopsy as a research priority. Conclusion:Several high-quality guidelines exist for NAFLD assessment, with no complete agreement on whether to screen high-risk patients and on the tests and biomarkers suggested to stratify patients and select those to be referred to liver biopsy.

The Visceral Adiposity Index in Non-Alcoholic Fatty Liver Disease and Liver Fibrosis—Systematic Review and Meta-Analysis

“…In this context, the accuracy of several anthropometric indicators, biomarkers, and complex models have been evaluated in predicting NAFLD and quantifying liver fibrosis [ 17 ]. The current guidelines recommend several noninvasive biomarkers and scores for predicting hepatic steatosis and steatohepatitis, such as the fatty liver index (FLI) and the NAFLD liver fat score [ 18 , 19 ].…”

Non-alcoholic fatty liver disease: a multidisciplinary clinical practice approach—the institutional adaptation to existing Clinical Practice Guidelines

“…Some of them are the definition of NAFLD, recommendations for clinical practice, screening strategies in high-risk subjects, favorable non-invasive tests, and biomarkers for NAFLD diagnosis, selecting patients to liver biopsy and therapy approach [82,83] . However, these variances rather are caused by population specificity, such as genetic predisposition to NAFLD, lifestyle, primary health care, than the inability to find consensus [82,83] . Among other high-risk subjects, those with diabetes or obesity should be systematically screened for NAFLD since evidence indicates higher NASH frequency and advanced fibrosis stages in patients with type 2 diabetes [84,85] .…”

“…Even though several international guidelines for NAFLD assessment were published and supported by reputable scientific societies with experts in hepatology, there are still numerous inconsistent attitudes. Some of them are the definition of NAFLD, recommendations for clinical practice, screening strategies in high-risk subjects, favorable non-invasive tests, and biomarkers for NAFLD diagnosis, selecting patients to liver biopsy and therapy approach [82,83] . However, these variances rather are caused by population specificity, such as genetic predisposition to NAFLD, lifestyle, primary health care, than the inability to find consensus [82,83] .…”

Pharmacotherapy for Non-Alcoholic Fatty Liver Disease: Emerging Targets and Drug Candidates

“…Non-alcoholic fatty liver disease (NAFLD) includes a range of chronic conditions characterized by excessive hepatic lipid accumulation, defined by the presence of steatosis in >5% of hepatocytes, in the absence of significant alcohol consumption or other causes of liver injury [ 1 ]. The global prevalence of NAFLD is currently estimated at 25% [ 2 ], and is projected to increase by 21% by 2030 [ 3 ]. About 20–25% of NAFLD cases are classified as non-alcoholic steatohepatitis (NASH), which has a substantially higher risk of progression to liver fibrosis, cirrhosis, and end-stage liver disease, and hepatocellular carcinoma (HCC) [ 3 ].…”

“…Due to the increasingly high medical and socioeconomic burden of this disease as well as its strong association with obesity, metabolic and cardiovascular disorders, NAFLD pharmacotherapy has been the focus of latest research [ 3 , 5 ]. However, to date, no drug has been approved by neither the European Medicines Agency nor the United States Food and Drug Administration (FDA) for NAFLD [ 2 , 6 ].…”