Evidence‐based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Abstract

Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in industrialized countries worldwide, and has become a serious public health issue not only in Western countries but also in many Asian countries including Japan. Within the wide spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is a progressive form of disease, which often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma. In turn, a large proportion of NAFLD/NASH is the liver manifestation of metabolic syndrome, suggesting that NAFLD/NASH plays a key role in the pathogenesis of systemic atherosclerotic diseases. Currently, a definite diagnosis of NASH requires liver biopsy, though various non-invasive measures are under development. The mainstays of prevention and treatment of NAFLD/NASH include dietary restriction and exercise; however, pharmacological approaches are often necessary. Currently, vitamin E and thiazolidinedione derivatives are the most evidence-based therapeutic options, although the clinical evidence for long-term efficacy and safety is limited. This practice guideline for NAFLD/NASH, established by the Japanese Society of Gastroenterology in cooperation with The Japan Society of Hepatology, covers lines of clinical evidence reported internationally in the period starting from 1983 through January 2012, and each clinical question was evaluated using the GRADE system. Based on the primary release of the full version in Japanese, this English summary provides the core essentials of this clinical practice guideline comprising the definition, diagnosis, and current therapeutic recommendations for NAFLD/NASH in Japan.

Prevalence of nonalcoholic steatohepatitis in Japanese patients with morbid obesity undergoing bariatric surgery

“…As expected, abnormal liver function test results were significantly related to NASH in this study, as has been reported previously [13,16,18]. There has been intense interest in the development of biochemical markers and scoring systems for predicting NASH and fibrosis [34]. To predict NASH, scoring systems including the hypertension, ALT, and insulin resistance (HAIR) score [6], Palekar's score [35], the Nash test [36], Gholam's score [37], the NASH clinical scoring system [38], the Nice model [39], and the NAFIC score [40] have been reported.…”

Comparative efficacy of interventions on nonalcoholic fatty liver disease (NAFLD)

“…NAFL is defined as the presence of hepatic steatosis without hepatocellular injury, whereas NASH is characterized by NAFL with hepatocellular ballooning injury with or without fibrosis. [1] NAFLD is now the most common cause of chronic liver disease worldwide [2] and affects 15% to 30% of the general population but is more prevalent (about 50%–90%) in patients with diabetes, metabolic syndrome, and severe obesity. [ 1 3 ] Current evidence suggests that 68% of adults in the United States are overweight, estimating that 75 to 100 million individuals may have NAFLD.…”

A Customized Online Nutrition Guidance System Is Effective for Treating Patients with Nonalcoholic Fatty Liver Disease by Supporting Continuity of Diet Therapy at Home: A Pilot Study

“…The anti-oxidant vitamin E and the insulin sensitizer pioglitazone are reported to be effective against NAFLD, but their long-term safety, especially for pioglitazone, are not well understood (5,6). Although clinical trials of several new drugs, including farnesoid X receptor agonist and PPARα/δ agonist, are ongoing (7,8), there is no curative drug treatment for NAFLD at present.…”