Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice

Abstract

With the increasing number of individuals with diabetes and obesity, nonalcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent, affecting one-quarter of adults worldwide. The spectrum of NAFLD ranges from simple steatosis or nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). NAFLD, especially NASH, may progress to fibrosis, leading to cirrhosis and hepatocellular carcinoma. NAFLD can impose a severe economic burden, and patients with NAFLD-related terminal or deteriorative liver diseases have become one of the main groups receiving liver transplantation. The increasing prevalence of NAFLD and the severe outcomes of NASH make it necessary to use effective methods to identify NAFLD. Although recognized as the gold standard, biopsy is limited by its sampling bias, poor acceptability, and severe complications, such as mortality, bleeding, and pain. Therefore, noninvasive methods are urgently needed to avoid biopsy for diagnosing NAFLD. This review discusses the current noninvasive methods for assessing NAFLD, including steatosis, NASH, and NAFLD-related fibrosis, and explores the advantages and disadvantages of measurement tools. In addition, we analyze potential noninvasive biomarkers for tracking disease processes and monitoring treatment effects, and explore effective algorithms consisting of imaging and nonimaging biomarkers for diagnosing advanced fibrosis and reducing unnecessary biopsies in clinical practice.

Simple Noninvasive Scores Are Clinically Useful to Exclude, Not Predict, Advanced Fibrosis: A Study in Turkish Patients with Biopsy-Proven Nonalcoholic Fatty Liver Disease

“…The noninvasive identification of liver fibrosis remains a major challenge in the hepatology practice, and numerous unnecessary biopsies are still being performed in patients with NAFLD. 18 An important finding of our study is that FIB-4 could avoid 67.1% of all biopsies as compared with 57.0% of NFS. These observations, coupled with the easier calculation of FIB-4 (four variables) compared with NFS (six variables), clearly support the routine use of the former score over the latter.…”

“…In this regard, it should be noted that the diagnostic performances of compound surrogates may be influenced by potential confounders (e.g., patient age, prevalence of different fibrosis stages, and different NAFLD disease spectrum). [12][13][14][15][16][17][18][19] These limitations notwithstanding, our results indicate that the main clinical utility of FIB-4 and NFS in patients with NAFLD lies in their ability to exclude, rather than identify, advanced fibrosis. Specifically, the routine application of FIB-4, a simple compound surrogate based on four parameters, is expected to reduce the number of liver biopsy by nearly 70%.…”

Relationship between visceral adipose tissue and triglyceride glucose index with liver status in men and women with metabolic syndrome features: sex differences

“…However, it has several limitations such as sampling error, cost, medical complications, and technical di culties [48]. In this regard, many techniques have been used in the detection and featuring NAFLD that showed to be relatively effective, inexpensive and useful in a primary health care setting [20,[48][49][50]. The TyG index is a novel marker that has exhibited a good accuracy for recognizing insulin resistance [21,51].…”

The immunoreactivity of TGF-b1 in non-alcoholic fatty liver disease

“…Although liver biopsy is still a gold standard to estimate fibrosis stage, new techniques are now under validation for noninvasive fibrosis evaluation, e.g. serum marker panels [10], elastography [11], and functional breath tests [12].…”