The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

Chalasani, Naga; Younossi, Zobair M.; Lavine, Joel E.; Diehl, Anna Mae; Brunt, Elizabeth M.; Cusi, Kenneth; Charlton, Michael; Sanyal, Arun J.

doi:10.1002/hep.25762

Cited by 3,072 publications

(1,976 citation statements)

References 198 publications

(220 reference statements)

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“…MRI‐PDFF and MRE have been demonstrated to be accurate tools for the detection of steatosis8, 9, 10 and fibrosis 11, 12, 13. MRE performance to distinguish various fibrosis stages has been shown to have an AUROC between 0.82 and 0.8931 but has been limited to distinguish NAFL from NASH (AUROC of 0.70) 30. In addition, MRI‐PDFF and MRE are expensive and require special software.…”

Section: Discussionmentioning

confidence: 99%

“…Cytokine keratin 18 initially gained interest and was suggested in practice guidelines as a tool to distinguish NAFLD from NASH. However, recent studies have commented on its lack of reproducibility and reliability 31, 32. The NAFLD‐fibrosis score is calculated based on age, BMI, hyperglycemia or diabetes, aspartate aminotransferase (AST), alanine aminotransferase (ALT), platelets, and albumin (http://www.nafldscore.com), while the FIB‐4 index33 is based on age, AST, ALT, and platelets.…”

Section: Discussionmentioning

confidence: 99%

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Metabolomic‐based noninvasive serum test to diagnose nonalcoholic steatohepatitis: Results from discovery and validation cohorts

Mayo

Crespo

Martínez‐Arranz

et al. 2018

Hepatology Communications

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139

114

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Nonalcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease worldwide and includes a broad spectrum of histologic phenotypes, ranging from simple hepatic steatosis or nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). While liver biopsy is the reference gold standard for NAFLD diagnosis and staging, it has limitations due to its sampling variability, invasive nature, and high cost. Thus, there is a need for noninvasive biomarkers that are robust, reliable, and cost effective. In this study, we measured 540 lipids and amino acids in serum samples from biopsy‐proven subjects with normal liver (NL), NAFL, and NASH. Using logistic regression analysis, we identified two panels of triglycerides that could first discriminate between NAFLD and NL and second between NASH and NAFL. These noninvasive tests were compared to blinded histology as a reference standard. We performed these tests in an original cohort of 467 patients with NAFLD (90 NL, 246 NAFL, and 131 NASH) that was subsequently validated in a separate cohort of 192 patients (7 NL, 109 NAFL, 76 NASH). The diagnostic performances of the validated tests showed an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.88 ± 0.05, 0.94, and 0.57, respectively, for the discrimination between NAFLD and NL and 0.79 ± 0.04, 0.70, and 0.81, respectively, for the discrimination between NASH and NAFL. When the analysis was performed excluding patients with glucose levels >136 mg/dL, the area under the receiver operating characteristic curve for the discrimination between NASH and NAFL increased to 0.81 ± 0.04 with sensitivity and specificity of 0.73 and 0.80, respectively. Conclusion: The assessed noninvasive lipidomic serum tests distinguish between NAFLD and NL and between NASH and NAFL with high accuracy. (Hepatology Communications 2018;2:807‐820)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Metabolomic‐based noninvasive serum test to diagnose nonalcoholic steatohepatitis: Results from discovery and validation cohorts

Mayo

Crespo

Martínez‐Arranz

et al. 2018

Hepatology Communications

Self Cite

139

114

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“…Second, we used US or unenhanced CT as the mode of diagnosis for NAFLD, while liver biopsy is regarded as the gold standard. Furthermore, without liver biopsy, it is impossible to characterize liver histology such as degree of fibrosis and distinguish between nonalcoholic fatty liver and nonalcoholic steatohepatitis because nonalcoholic steatohepatitis can progress to cirrhosis, liver failure, and liver cancer and increase hepatic and extrahepatic morbidity and mortality (Chalasani et al 2012). However, a meta-analysis from 46 articles comparing various imaging modalities to liver biopsy for diagnosis of NAFLD concluded that mean sensitivity estimates for US and CT were 73.3-90.5 and 46.1-72.0%, respectively, and mean specificity range were 69.6-85.2 and 88.1-94.6% respectively (Bohte et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Nonalcoholic fatty liver disease is a negative risk factor for prostate cancer recurrence

Choi¹,

Lee²,

Yoon³

et al. 2014

Endocrine-Related Cancer

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Nonalcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome, which is associated with an increased risk of various malignancies. In this study, we investigated the association between NAFLD and prostate cancer biochemical recurrence (BCR) after radical prostatectomy. Consecutive prostate cancer patients who underwent radical prostatectomy were enrolled from two hospitals in Korea and randomly assigned to the training (nZ147) or validation set (nZ146). The presence of NAFLD, BMI, preoperative prostate-specific antigen, and histological findings including Gleason score (GSc) were analyzed in regard to their association with BCR. NAFLD was diagnosed based on ultrasonography or unenhanced computed tomography images. BCR-free survival rates were calculated using the KaplanMeier method. In the training set, 32 (21.8%) patients developed BCR during a median follow-up period of 51 (inter-quartile range, 35-65) months. In the multivariate analysis, the presence of NAFLD (hazard ratio (HR), 0.36; 95% CI, 0.14-0.97; PZ0.04) was an independent negative predictive factor of BCR after adjustment for pathological GSc. Applied to the validation set, the presence of NAFLD maintained its prognostic value for longer time-to-BCR (HR, 0.17; 95% CI, 0.06-0.49; PZ0.001). In the subgroup analysis of patients with NAFLD, NAFLD fibrosis score was a single independent negative predictor for BCR (HR, 0.54; 95% CI, 0.30-0.98; PZ0.04). Our study demonstrated that NAFLD may play a protective role against BCR after radical prostatectomy for prostate cancer. Further study is warranted to elucidate the mechanism of protective effect in patients with NAFLD.

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“…The histologic features of NAFLD range from isolated steatosis to nonalcoholic steatohepatitis (NASH), the latter being characterized by hepatic steatosis, lobular inflammation, and signs of hepatocyte injury (ballooning) with or without fibrosis 5. Some patients with NAFLD develop progressive fibrosis and subsequent cirrhosis with an increased risk of hepatocellular carcinoma 6.…”

Section: Introductionmentioning

confidence: 99%

Natural history of nonalcoholic fatty liver disease: A prospective follow‐up study with serial biopsies

Nasr

Ignatova

Kechagias

et al. 2017

Hepatology Communications

128

104

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Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world. The complete natural history of NAFLD is unknown because few high‐quality follow‐up studies have been conducted. Our aim was to find variables predicting disease severity through an extended follow‐up with serial biopsies. In a prospective cohort study, 129 patients who enrolled between 1988 and 1993 were asked to participate in a follow‐up study on two occasions; biochemical, clinical, and histologic data were documented. The mean time between biopsies was 13.7 (±1.7) and 9.3 (±1.0) years, respectively. At the end of the study period, 12 patients (9.3%) had developed end‐stage liver disease and 34% had advanced fibrosis. Out of the 113 patients with baseline low fibrosis (<3), 16% developed advanced fibrosis. Fibrosis progression did not differ among the different stages of baseline fibrosis (P = 0.374). Fifty‐six patients (43%) had isolated steatosis, of whom 9% developed advanced fibrosis (3 patients with biopsy‐proven fibrosis stage F3‐F4 and 2 patients with end‐stage liver disease). Fibrosis stage, ballooning, and diabetes were more common in patients who developed end‐stage liver disease; however, there were no baseline clinical, histologic, or biochemical variables that predicted clinical significant disease progression. Conclusion: NAFLD is a highly heterogeneous disease, and it is surprisingly hard to predict fibrosis progression. Given enough time, NAFLD seems to have a more dismal prognosis then previously reported, with 16% of patients with fibrosis stage <3 developing advanced fibrosis and 9.3% showing signs of end‐stage liver disease. (Hepatology Communications 2018;2:199–210)

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The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

Cited by 3,072 publications

References 198 publications

Metabolomic‐based noninvasive serum test to diagnose nonalcoholic steatohepatitis: Results from discovery and validation cohorts

Metabolomic‐based noninvasive serum test to diagnose nonalcoholic steatohepatitis: Results from discovery and validation cohorts

Nonalcoholic fatty liver disease is a negative risk factor for prostate cancer recurrence

Natural history of nonalcoholic fatty liver disease: A prospective follow‐up study with serial biopsies

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