KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

Kang, Seong Hee; Lee, Hye Won; Yoo, Jeong‐Ju; Cho, Yuri; Kim, Seung Up; Lee, Tae Hee; Jang, Byoung Kuk; Kim, Sang Gyune; Ahn, Sang Bong; Kim, Haeryoung; Jun, Dae Won; Choi, Joon Il; Song, Do Seon; Kim, Won; Jeong, Soung Won; Kim, Moon Young; Koh, Hong; Jeong, Su Jin; Lee, Jin Woo; Cho, Yong Kyun

doi:10.3350/cmh.2021.0178

Cited by 159 publications

(173 citation statements)

References 411 publications

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“…Nonalcoholic fatty liver disease (NAFLD), characterized by hepatic fat infiltration without a secondary cause of fatty liver, is closely associated with diabetes mellitus (DM), obesity, and metabolic syndrome due to insulin resistance (IR) [1,2]. The prevalence of NAFLD is approximately 30% in South Korea, similar to that in Europe and North America (approximately 24%), and is expected to rise due to an increase in the aging population and obesity [2][3][4]. NAFLD represents a wide spectrum of liver diseases with variable prognoses, ranging from simple steatosis, nonalcoholic steatohepatitis, advanced fibrosis, cirrhosis, and hepatocellular carcinoma [1].…”

Section: Introductionmentioning

confidence: 99%

Association between Fasting Ketonuria and Advanced Liver Fibrosis in Non-Alcoholic Fatty Liver Disease Patients without Prediabetes and Diabetes Mellitus

2021

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Ketone body production, an alternative fuel upon low glucose availability, reduces hepatic fat accumulation. However, its clinical implications have not been established in patients with nonalcoholic fatty liver disease (NAFLD). We investigated the association between spontaneous fasting ketonuria and liver fibrosis in patients with NAFLD without prediabetes and diabetes mellitus (DM). A total of 6202 patients with ultrasound confirmed NAFLD without prediabetes and DM were enrolled in the study. Using low cut off values of NAFLD fibrosis score (NFS) and fibrosis-4, liver fibrosis was defined as an intermediate–high probability of advanced liver fibrosis. Of the 6202 NAFLD patients, 360 (5.8%) had ketonuria. Compared to the patients without ketonuria, patients with ketonuria were younger (41.1 vs. 44.6 years, p < 0.001), had lower levels of glucose (87.2 vs. 91.0 mg/dL, p < 0.001), and homeostatic model assessment for insulin resistance (1.0 vs. 1.5, p < 0.001). The presence of ketonuria had an inverse association with liver fibrosis, assessed using both NFS (final adjusted odds ratio [aOR], 0.67; 95% confidence interval [CI], 0.45–1.01) and fibrosis-4 (aOR, 0.58; 95% CI, 0.40–0.84). The presence of ketonuria in NAFLD patients without prediabetes and DM may have favorable metabolic effects compared to the absence of ketonuria, independent of traditional metabolic factors.

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Section: Introductionmentioning

confidence: 99%

Association between Fasting Ketonuria and Advanced Liver Fibrosis in Non-Alcoholic Fatty Liver Disease Patients without Prediabetes and Diabetes Mellitus

2021

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“…Second, this study was conducted with a large number of patients who were followed for a long-term period in high-volume hospitals in the ROK. In addition, all subjects in our study had information regarding TE results to assess the degree of liver fibrosis and diagnose NAFLD with higher accuracy and subjectivity [ 2 , 16 , 20 , 34 ]. Indeed, to the best of our knowledge, this study is the first to conduct risk stratification of HCC in patients with NAFLD based on TE results.…”

Section: Discussionmentioning

confidence: 99%

“…Clinicians may use cirrhosis instead of the highest LS categorization score. Further studies are needed to investigate whether fibrosis assessment based on TE can be substituted with other noninvasive surrogates such as the fibrosis-4 index for application in primary care clinics [ 2 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, non-alcoholic fatty liver disease (NAFLD) is known to affect about one quarter of the global population [ 1 ]. The prevalence of NAFLD in the Republic of Korea (ROK) is also rapidly increasing, and is estimated to account for approximately 30% of the general population in the country [ 2 , 3 ]. Approximately 20% of the patients with NAFLD develop nonalcoholic steatohepatitis (NASH), a chronic inflammatory condition that is associated with altered lipid metabolism, and has an increased risk of cirrhosis and hepatocellular carcinoma (HCC) [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Liver Stiffness-Based Risk Prediction Model for Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease

Lee

Sinn

Park

et al. 2021

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Non-alcoholic fatty liver disease (NAFLD) is associated with an increased hepatocellular carcinoma (HCC) risk. We established and validated a liver stiffness (LS)-based risk prediction model for HCC development in patients with NAFLD. A total of 2666 and 467 patients with NAFLD were recruited in the training and validation cohorts, respectively. NAFLD was defined as controlled attenuated parameter ≥238 dB/m by transient elastography. Over a median of 64.6 months, HCC developed in 22 (0.8%) subjects in the training cohort. Subjects who developed HCC were older and had higher prevalence of diabetes and cirrhosis, lower platelet count, and higher AST levels compared to those who did not develop HCC (all p < 0.05). In multivariate analysis, age ≥60 years (hazard ratio (HR) = 9.1), platelet count <150 × 103/μL (HR = 3.7), and LS ≥9.3 kPa (HR = 13.8) were independent predictors (all p < 0.05) that were used to develop a risk prediction model for HCC development, together with AST ≥34 IU/L. AUCs for predicting HCC development at 2, 3, and 5 years were 0.948, 0.947, and 0.939, respectively. This model was validated in the validation cohort (AUC 0.777, 0.781, and 0.784 at 2, 3, and 5 years, respectively). The new risk prediction model for NAFLD-related HCC development showed acceptable performance in the training and validation cohorts.

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“…However, liver biopsy has certain disadvantages, such as sampling error and inter-/intraobserver variation, and there is a risk of complications such as pain, infection, and bleeding [5]. Given the remarkable increase in global NAFLD prevalence in recent years, liver biopsies cannot be performed in all patients [6,7]. Therefore, noninvasive evaluation of NAFLD severity has been developed using serological and imaging biomarkers [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the severity of nonalcoholic fatty liver disease through analysis of serum exosomal miRNA expression

et al. 2021

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Noninvasive techniques for evaluating the severity of nonalcoholic fatty liver disease (NAFLD) have shown limited diagnostic performance. MicroRNAs (miRNAs) are useful biomarkers for diagnosing and monitoring the progression and treatment response to several diseases. Here, we evaluated whether serum exosomal miRNAs could be used for the diagnosis and prognosis of NAFLD severity. Exosomal miRNAs were isolated from the sera of 41 patients with NAFLD (diagnosed using liver biopsy) for microarray profiling. The degree of NAFLD severity was determined using inflammation, steatosis, and ballooning scores and the NAFLD activity score (NAS). Correlations between miRNA expression, clinical and biochemical parameters, and mRNA expression were analyzed. Overall, 25, 11, 13, and 14 miRNAs correlated with the inflammation score, steatosis score, ballooning score, and NAS, respectively, with 33 significant correlations observed between 27 miRNAs and six clinical variables. Eight miRNAs (let-7b-5p, miR-378h, -1184, -3613-3p, -877-5p, -602, -133b, and 509-3p) showed anticorrelated patterns with the corresponding mRNA expression. In fibrosis, 52 and 30 interactions corresponding to high miRNA-low mRNA and low miRNA-high mRNA expression, respectively, were observed. The present results therefore suggest that serum exosomal miRNAs can be used to evaluate NAFLD severity and identify potential targets for NAFLD treatment.

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KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

Abstract: Medison.Sang Bong Ahn has received grants from Hanwha, Samjin, Ildong, and Hanmi.Dae Won Jun has served as an advisory committee member of Sysmax, J2H, and Future medicine. He is a speaker for Gilead Sciences,

Cited by 159 publications

References 411 publications

Association between Fasting Ketonuria and Advanced Liver Fibrosis in Non-Alcoholic Fatty Liver Disease Patients without Prediabetes and Diabetes Mellitus

Association between Fasting Ketonuria and Advanced Liver Fibrosis in Non-Alcoholic Fatty Liver Disease Patients without Prediabetes and Diabetes Mellitus

Liver Stiffness-Based Risk Prediction Model for Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease

Evaluation of the severity of nonalcoholic fatty liver disease through analysis of serum exosomal miRNA expression

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