Nonalcoholic Fatty Liver Disease 2020: The State of the Disease

Cotter, Thomas G.; Rinella, Mary E.

doi:10.1053/j.gastro.2020.01.052

Cited by 783 publications

(626 citation statements)

References 147 publications

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“…Fifth, the serum miRNA test could be used for the early diagnosis of NASH in clinical practice. (1) In general, serum miRNA showed moderate e cacy for diagnosis of NASH. In terms of clinical utility, Fagan's nomogram revealed that when a patient was in a dilemma about diagnosis or exclusion of NASH, miRNA could provide an effective reference: if a positive result was acquired, the patient would have 83% probability of con rmation by liver biopsy; If a negative result was acquired, the patient would has 76% probability of exclusion by liver biopsy.…”

Section: Discussionmentioning

confidence: 98%

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Efficacy of serum miRNA test as a non-invasive method to diagnose nonalcoholic steatohepatitis: a systematic review and meta-analysis.

Xin

Zhan

Chen

et al. 2020

Preprint

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1. Background: Nonalcoholic steatohepatitis (NASH) is a key turning point during the progression of nonalcoholic fatty liver disease (NAFLD). Recent studies have shown that serum miRNA tests may be effective in the diagnosis of NAFLD. We conducted a meta-analysis to assess the evidence for the diagnostic efficacy of serum miRNAs in patients with NAFLD and its subtype, NASH, in particular. 2. Methods: After a systematic review, sensitivity, specificity, and area under the receiver operating characteristics curve (AUROC) were pooled to determine the efficacy of serum miRNA test for the diagnosis of NAFLD and NASH. Clinical utility was evaluated by Fagan’s nomogram and likelihood ratio scattergram. Heterogeneity was evaluated by subgroup analysis and meta-regression. Publication bias was detected by Deeks’ funnel plot. 3. Results: We included 27 trials containing 1775 NAFLD patients (including simple steatosis and NASH) and 586 NASH patients. For NAFLD vs NASH, the pooled sensitivity, specificity, and AUROC were (0.71 vs. 0.74), (0.76 vs. 0.85) and (0.80 vs. 0.86), respectively. Serum miRNA had high accuracy for distinguishing NASH from simple steatosis, with an AUROC of 0.91. Among the most commonly studied serum miRNAs , miRNA-34a showed moderate diagnostic accuracy for NAFLD and the lowest heterogeneity (sensitivity I 2 = 5.73%, specificity I 2 = 33.16%, AUROC = 0.85). According to subgroup analysis and meta-regression, a lower BMI ( < 30 kg/m 2 ) might be a crucial source of heterogeneity. 4.Conclusions: As a novel non-invasive method, serum miRNA test exhibited robust diagnostic efficacy for NASH. Among these well-studied miRNAs, miRNA-34a was more available for diagnosis. Diagnosis of NAFLD by serum miRNA is more likely to be accurate in patients with BMI ≥ 30kg/m 2 .

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Section: Discussionmentioning

confidence: 98%

“…Previous studies have shown that miRNA-34a plays pivotal roles in NAFLD progression. (1) In terms of lipid metabolism, miRNA-34a can downregulate the PPARα signaling pathway. PPARα is a key transcription factor of fatty acid oxidation that facilitates the transfer of fatty acids into the mitochondria for oxidation.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of serum miRNA test as a non-invasive method to diagnose nonalcoholic steatohepatitis: a systematic review and meta-analysis.

Xin

Zhan

Chen

et al. 2020

Preprint

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“…Nonalcoholic fatty liver disease (NAFLD) has become a heavy burden in liver disease. The latest epidemiological data shows that the prevalence of NAFLD worldwide is approximately 25% [1]. In developed countries, such as the United States, the prevalence of NAFLD is 30% [1].…”

Section: Introductionmentioning

confidence: 99%

“…The latest epidemiological data shows that the prevalence of NAFLD worldwide is approximately 25% [1]. In developed countries, such as the United States, the prevalence of NAFLD is 30% [1]. In developing countries, such as China, the prevalence also reaches 32.9% [2].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic efficacy of serum miRNA as a non-invasive method for nonalcoholic steatohepatitis: a systematic review and meta-analysis.

Xin

Zhan

Chen

et al. 2020

Preprint

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1. Background: Nonalcoholic steatohepatitis (NASH) is a key turning point in the progression of nonalcoholic fatty liver disease (NAFLD). As a non-invasive method , serum miRNA levels may provide an effective reference for the diagnosis of NASH. This article systematically reviewed related diagnostic trials to compare the difference in the efficacy of serum miRNAs in the diagnosis of NAFLD and its subtype, NASH, and identify the influencing factors. 2. Methods: We pooled the sensitivity (SEN), specificity (SPE), and area under receiver operating characteristics (AUROC) of each trail to determine the efficacy of serum miRNAs in the diagnosis of NAFLD and NASH; Clinical utility was evaluated by Fagan`s nomogram; Heterogeneity was evaluated by subgroup analysis and meta-regression. Publication bias was detected by Deek’s funnel plot. 3. Results: We included 9 articles consisting of 27 trials and 2361 cases, 1775 NAFLD patients (not distinguishing between simple steatosis and NASH) and 586 NASH patients were collected. All cases were confirmed by biopsy. For NAFLD and NASH, the pooled values were SEN (0.71 vs. 0.74), SPE (0.76 vs. 0.85) and AUROC (0.80 vs. 0.86). miRNA had a high accuracy in distinction NASH from simple steatosis with AUROC at 0.91. Among the well-studied serum miRNAs, miRNA-34a showed a moderate accuracy with the lowest heterogeneity in diagnosing NAFLD (SPE I 2 : 5.73%, SPE I 2 : 33.16%, AUROC: 0.85). According to subgroup analysis and meta-regression, lower BMI ( <30kg/m 2 ) may be a crucial source of heterogeneity and reduced the performance of serum miRNA in the diagnosis of NAFLD. 4. Conclusions: As a non-invasive method, serum miRNA should be considered a promising parameter in the diagnosis of NASH. Generally, NAFLD patients with higher BMI ( ≥ 30kg/m 2 ) are more likely to be diagnosed accurately by serum miRNA.

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