Differences between current clinical guidelines for screening, diagnosis and management of nonalcoholic fatty liver disease and real-world practice: a targeted literature review

Schattenberg, Jörn M.; Anstee, Quentin M.; Caussy, Cyrielle; Bugianesi, Elisabetta; Popović, B.

doi:10.1080/17474124.2021.1974295

Cited by 12 publications

(15 citation statements)

References 90 publications

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“…Instead, scientists designed noninvasive approaches like computed tomography and magnetic resonance imaging to detect NAFLD. However, these approaches are both costly and time-consuming, and are not suitable for the screening and application of large-scale population [ 47 ]. Thus, simple and convenient new synthetic biological indexes, namely LAP and CMI, are of great significance to the general screening of NAFLD.…”

Section: Discussionmentioning

confidence: 99%

Sex-specific contribution of lipid accumulation product and cardiometabolic index in the identification of nonalcoholic fatty liver disease among Chinese adults

Liu

Wang

2022

Lipids Health Dis

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Background Lipid accumulation product (LAP) and cardiometabolic index (CMI) are two novel obesity-related indexes associated with enhancing metabolic disease (MD) risk. Current evidences suggest that the differences in sex hormones and regional fat distribution in both sexes are directly correlated with MD and nonalcoholic fatty liver disease (NAFLD) risk. Hence, NAFLD incidences reflect sex differences. Herein, we examined the accuracy of LAP and CMI in diagnosing NAFLD in both sexes. Methods Overall, 14,407 subjects, who underwent health check-up in the northeastern China, were enrolled in this study, and their corresponding LAP and CMI were calculated. Abdominal ultrasonography was employed for NAFLD diagnosis. Multivariate analyses were analyzed potential correlations between LAP and/or CMI and NAFLD. Odds ratios (ORs) and 95% confidence intervals (CIs) were evaluated. Receiver operating characteristic curve analyses was executed for the exploration of the diagnostic accuracies. Areas under the curves (AUCs) with 95%CIs were calculated. Results NAFLD prevalence increased with elevated quartiles of LAP and CMI in both sexes. In multivariate logistic regression analyses, LAP and CM expressed as continuous variables or quartiles, significantly correlated with NAFLD. The ORs for the top versus bottom quartile of LAP and CMI for NAFLD were 13.183 (95%CI = 8.512–20.417) and 8.662 (95%CI = 6.371–11.778) in women and 7.544 (95%CI = 5.748–9.902) and 5.400 (95%CI = 4.297–6.786) in men. LAP and CMI exhibited larger AUCs, compared to other obesity-related indexes in terms of discriminating NAFLD. The AUCs of LAP and CMI were 0.860 (95%CI = 0.852–0.867) and 0.833 (95%CI = 0.825–0.842) in women and 0.816 (95%CI = 0.806–0.825) and 0.779 (95%CI = 0.769–0.789) in men. Conclusions LAP and CMI are convenient indexes for the screening and quantification of NAFLD within a Chinese adult population. Their associations with NAFLD are substantially greater in women than men.

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Section: Discussionmentioning

confidence: 99%

Sex-specific contribution of lipid accumulation product and cardiometabolic index in the identification of nonalcoholic fatty liver disease among Chinese adults

Liu

Wang

2022

Lipids Health Dis

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“…Body mass index (BMI) was calculated as weight (kg)/height (m) 2 . Obesity was defined as BMI ≥ 30 kg/m 2 , while overweight was defined as BMI > 25 to <30 kg/m 2 .…”

Section: Presence Of Comorbiditiesmentioning

confidence: 99%

“…Currently, it is not recommended to screen for liver disease in an asymptomatic, non‐at‐risk population. ( 2 ) Therefore, by extrapolating the available data from tertiary care referral cohorts, the true prevalence of liver disease at a population level is overestimated. In the population‐based National Health and Nutrition Examination Survey (NHANES) III, elevated serum aminotransferase activity was reported in 7.9% of the included population sample enrolled between 1988 until 1994 in the United States.…”

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confidence: 99%

Prevalence and Risk Factors of Advanced Liver Fibrosis in a Population‐Based Study in Germany

et al. 2022

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The prevalence of liver disease, and especially of advanced liver fibrosis, in the German population is poorly defined. The aim of the study was to explore liver enzymes and surrogate scores of hepatic steatosis and advanced hepatic fibrosis in a population‐based cohort study in Germany. In the cross‐sectional population‐based Gutenberg Health study, data of 14,950 participants enrolled between 2007 and 2012 were captured and analyzed. The distribution of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma‐glutamyltransferase (GGT), fatty liver index (FLI), and Fibrosis‐4 (FIB‐4) score, as well as the underlying risk factors, were assessed by regression models. Elevated liver enzymes in this population‐based sample were seen in 19.9% for ALT, 12.8% for AST, and 14% for GGT. Risk factors for liver disease included alcohol use and the presence of the metabolic syndrome, which were both risk factors associated with increased liver enzymes. The FLI suggested that 37.5% of the population exhibited hepatic steatosis and 1.1% of patients exhibited a FIB‐4 above the upper cutoff, while 19.2% were in the intermediate range. Interestingly, advanced fibrosis was significantly more frequent in men compared with women (FIB‐4: 1.5% vs. 0.6% [P < 0.0001]; NFS: 3.6% vs. 1.9% [P < 0.0001]). In addition, age was a relevant risk factor for exhibiting a noninvasive surrogate score suggestive of advanced fibrosis in the current study population. Conclusion: Elevated liver enzymes were seen in almost a fifth of the German population. At the population‐based level, the prevalence of advanced fibrosis was estimated at 1% in Germany.

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“…A review of current international guidelines has recently been published [133]. In contrast to the AASLD, European and Asian guidelines recommend that screening be considered for groups considered at risk for developing NAFLD, including patients with obesity and T2D [3,90,91].…”

Section: Screening and Clinical Management Of Nafld In Lean Individua...mentioning

confidence: 99%

“…There should be a high index of suspicion for NAFLD and NASH in patients with type 2 diabetes Systematic screening of family members for NAFLD is not recommended NAFLD patients [133]. Knowledge of disease etiology, screening, detection methods, and consensus guidelines are becoming increasingly important for adequate clinical care of both lean and obese NAFLD patients, especially for primary care physicians, who are the providers in the best position to make an initial diagnosis.…”

Section: Screening and Clinical Management Of Nafld In Lean Individua...mentioning

confidence: 99%

NAFLD in normal weight individuals

DiStefano

Gerhard

2022

Diabetol Metab Syndr

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Nonalcoholic fatty liver disease (NAFLD) can develop in lean individuals. Despite a better metabolic profile, the risk of disease progression to hepatic inflammation, fibrosis, and decompensated cirrhosis in the lean is similar to that in obesity-related NAFLD and lean individuals may experience more severe hepatic consequences and higher mortality relative to those with a higher body mass index (BMI). In the absence of early symptoms and abnormal laboratory findings, lean individuals are not likely to be screened for NAFLD or related comorbidities; however, given the progressive nature of the disease and the increased risk of morbidity and mortality, a clearer understanding of the natural history of NAFLD in lean individuals, as well as efforts to raise awareness of the potential health risks of NAFLD in lean individuals, are warranted. In this review, we summarize available data on NAFLD prevalence, clinical characteristics, outcomes, and mortality in lean individuals and discuss factors that may contribute to the development of NAFLD in this population, including links between dietary and genetic factors, menopausal status, and ethnicity. We also highlight the need for greater representation of lean individuals in NAFLD-related clinical trials, as well as more studies to better characterize lean NAFLD, develop improved screening algorithms, and determine specific treatment strategies based on underlying etiology.

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Differences between current clinical guidelines for screening, diagnosis and management of nonalcoholic fatty liver disease and real-world practice: a targeted literature review

Cited by 12 publications

References 90 publications

Sex-specific contribution of lipid accumulation product and cardiometabolic index in the identification of nonalcoholic fatty liver disease among Chinese adults

Sex-specific contribution of lipid accumulation product and cardiometabolic index in the identification of nonalcoholic fatty liver disease among Chinese adults

Prevalence and Risk Factors of Advanced Liver Fibrosis in a Population‐Based Study in Germany

NAFLD in normal weight individuals

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