Clinical assessment and management of liver fibrosis in non-alcoholic fatty liver disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) is among the most frequent etiologies of cirrhosis worldwide, and it is associated with features of metabolic syndrome; the key factor influencing its prognosis is the progression of liver fibrosis. This review aimed to propose a practical and stepwise approach to the evaluation and management of liver fibrosis in patients with NAFLD, analyzing the currently available literature. In the assessment of NAFLD patients, it is important to identify clinical, genetic, and environmental determinants of fibrosis development and its progression. To properly detect fibrosis, it is important to take into account the available methods and their supporting scientific evidence to guide the approach and the sequential selection of the best available biochemical scores, followed by a complementary imaging study (transient elastography, magnetic resonance elastography or acoustic radiation force impulse) and finally a liver biopsy, when needed. To help with the selection of the most appropriate method a Fagan′s nomogram analysis is provided in this review, describing the diagnostic yield of each method and their post-test probability of detecting liver fibrosis. Finally, treatment should always include diet and exercise, as well as controlling the components of the metabolic syndrome, +/- vitamin E, considering the presence of sleep apnea, and when available, allocate those patients with advanced fibrosis or high risk of progression into clinical trials. The final end of this approach should be to establish an opportune diagnosis and treatment of liver fibrosis in patients with NAFLD, aiming to decrease/stop its progression and improve their prognosis.

AGL9: A Novel Hepatoprotective Peptide from the Larvae of Edible Insects Alleviates Obesity-Induced Hepatic Inflammation by Regulating AMPK/Nrf2 Signaling

“…In this study, we established an NAFLD mouse model recapitulating the pathophysiological changes observed in human NAFLD [ 19 ]. Although many NAFLD-related drugs are clinically efficacious, they are all associated with serious side effects and occasionally induce the development of drug resistance [ 4 , 20 ]. Therefore, the exploration of therapeutic agents exhibiting low toxicity and high efficiency, including those from natural foods, has become a popular area of research.…”

Clinical perspectives, assessment, and mechanisms of metabolic-associated fatty liver disease in patients with COVID-19

“…Finally, some of the pathways involved in liver fibrosis, which is the key event determining the outcome in patients with NAFLD[ 12 ], are specially relevant and could have an important role in patients with COVID-19. One of them, the RAAS, is involved in liver fibrosis development, where angiotensin II induces a profibrogenic phenotype in stellate cells and has an important role in the pathophysiology of cirrhosis[ 47 , 48 ].…”

“…Furthermore, elastography is not widely available in all hospitals, and biosecurity measures could make it difficult to perform this evaluation of patients with COVID-19 and MAFLD. Noninvasive tools for the assessment of liver fibrosis include serologic tests, risk scores, and imaging studies[ 12 ]. None of the currently available biomarkers by itself has sufficient accuracy for diagnosing fibrosis, therefore, predictive scores have an important role in evaluating the risk of advanced fibrosis in patients with MAFLD.…”

“…It is regarded as the hepatic manifestation of metabolic syndrome[ 10 , 11 ]. The most important predictor of liver and non-liver-related outcomes in patients with MAFLD is the presence of liver fibrosis[ 12 ]. The association between metabolic risk factors such as obesity and diabetes, and MAFLD, means that the probability of facing patients with MAFLD and COVID-19 is high.…”

Mitochondrial Mutations and Genetic Factors Determining NAFLD Risk

“…Early and precise diagnostic criteria are crucial for effective therapy, today relying on lifestyle interventions and the amelioration of NAFLD-related complications [ 7 ]. The stage of fibrosis is the main marker, used to monitor the progression of the diseases, assign treatment, and predict a long-term outcome [ 8 ]. Current methods rely on invasive procedures (like biopsies) and non-invasive methods (blood-markers measurements and image-based).…”