Principles of risk stratification in nonalcoholic fatty liver disease. A narrative review emphasizing non-invasive strategies

Abstract

Nonalcoholic fatty liver disease (NAFLD) is an umbrella definition that describes the ectopic deposition of fat within the liver that occurs in the absence of inciting factors other than the metabolic syndrome and its individual features. NAFLD has a multi-factorial pathogenesis which determines heterogeneous clinical phenotypes and variable natural course spanning from liver-related (steatohepatitis, fibrosis, cirrhosis, hepatocellular carcinoma) to extrahepatic outcomes (cardio-metabolic and cancer). This narrative review article leverages the key aspects of disease natural history as the background information to discuss studies that may inform strategies to risk-stratify NAFLD patients. Evaluation of hepatic fibrosis with non-invasive tools, including blood-based biomarkers and imaging-based elastometry techniques, seemingly retains the core information useful to predict the heterogeneous outcomes listed above. Additionally, genetic testing and metabolomic profiles may also be utilized to this end. In conclusion, a comprehensive understanding of the variable hepatic, cardio-metabolic and cancer outcomes of NAFLD may enable physicians and researchers to risk-stratify and accurately identify the multilayered prognosis of NAFLD individuals while also defining homogeneous patient subsets to enroll in clinical trials.

PRO‐C3, liver fibrosis and CKD: The plot thickens

“…12 Interestingly, liver fibrosis is also a strong correlate of extrahepatic features of NAFLD, such as major adverse cardiovascular events, risk of incident diabetes and CKD. 14 On these grounds, given invasiveness, risks of complications, costs and inherent intraand inter-observer variability of findings of liver biopsy, tools to assess liver fibrosis non-invasively are eagerly awaited in as much as they could be leveraged to screen large patient populations as well as for monitoring disease progression and effectiveness of treatment. 3,15 The sequential utilization of non-invasive tests (such as FIB-4 and elastography or others) has rationally been proposed to this end, 15 but it may be difficult to implement in primary care settings globally.…”