The diagnostic conundrum in non-alcoholic fatty liver disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) has become the most common liver alteration worldwide. It encompasses a spectrum of disorders that range from simple steatosis to a progressive form, defined non-alcoholic steatohepatitis (NASH), that can lead to advanced fibrosis and eventually cirrhosis and hepatocellular carcinoma. On liver histology, NASH is characterized by the concomitant presence of significant fat accumulation and inflammatory reaction with hepatocellular injury. Until now, liver biopsy is still required to differentiate simple steatosis from NASH and evaluate the degree of liver fibrosis. Unfortunately, this technique has well-known limitations, including invasiveness and expensiveness. Moreover, it may be biased by sampling error and intra- or inter-observed variability. Furthermore, due to the increasing prevalence of NAFLD worldwide, to program a systematic screening with liver biopsy is not imaginable. In recent years, different techniques were developed and validated with the aim of non-invasively identifying NASH and assess liver fibrosis degrees. The non-invasive tests range from simple blood-tests analyses to composite scores and complex imaging techniques. Nevertheless, even if they could represent cost-effective strategies for diagnosing NASH, advanced fibrosis and cirrhosis, their accuracy and consequent usefulness are to be discussed. With this aim, in this review the authors summarize the current state of non-invasive assessment of NAFLD. In particular, in addition to the well-established tests, the authors describe the future perspectives in this field, reporting the latest tests based on OMICS, gut-miocrobioma and micro-RNAs. Finally, the authors provide an accurate assessment of how these non-invasive tools perform in clinical practice depending on the clinical context, with the aim of giving the clinicians a useful tool to try to resolve the diagnostic conundrum of NAFLD.

Effect of a Probiotic and a Synbiotic on Body Fat Mass, Body Weight and Traits of Metabolic Syndrome in Individuals with Abdominal Overweight: A Human, Double-Blind, Randomised, Controlled Clinical Study

“…Accidental difference is also indicated by the lack of differences in parameters that are associated with HDL-C as part of metabolic syndrome, such as weight, BMI, waist circumference, WHtR, blood pressure, plasma glucose and HOMA-IR [52,53]. Likewise, parameters associated with ALT, such as body weight, waist circumference, liver steatosis grade, AST and GGT [54], as well as CRP [55], did not differ. Thus, the three groups could be considered comparable in their baseline characteristics.…”

MAFLD/NAFLD Biopsy-Free Scoring Systems for Hepatic Steatosis, NASH, and Fibrosis Diagnosis

“…Quantitatively, FibroMeter has AUROC values of 0.94, 0.93, and 0.9 for significant fibrosis, advanced fibrosis, and cirrhosis, respectively (58,149). Furthermore, its results for fibrotic areas have an AUROC of 0.94, which is more accurate in comparison with that of the NAFLD fibrosis score (0.88) and APRI (0.87) (7,7,149,151,152). Nonetheless, some authors argued that ethnicity-specific cutoff values would increase its validity (153).…”

Tiếp cận chẩn đoán bệnh gan nhiễm mỡ liên quan chuyển hóa (Metabolic associatedfatty liver disease - MAFLD)

“…-Thừa cân hoặc béo phì (BMI ≥ 25kg/m 2 ở người da trắng hoặc ≥ 23kg/m 2 ở người Châu Á) -Đái tháo đường típ 2 -Bằng chứng tối thiểu có 2 đặc điểm của hội chứng chuyển hóa trên lâm sàng (Sơ đồ 1) Sơ đồ 1. Sự khác nhau giữa chẩn đoán bệnh gan nhiễm mỡ không do rượu và bệnh gan nhiễm mỡ liên quan chuyển hóa [13] Bên cạnh đó, trên những bệnh nhân xơ gan thì tỷ lệ mỡ gan giảm đáng kể dẫn đến việc chẩn đoán nguyên nhân do gan nhiễm mỡ khó khăn cũng được hướng dẫn chẩn đoán. Nếu các bệnh nhân xơ gan không có đặc điểm mô bệnh học đặc trưng nhưng thỏa các tiêu chuẩn của bệnh gan nhiễm mỡ liên quan chuyển hóa nên được cân nhắc chẩn đoán nếu có các bằng chứng trong quá khứ hoặc hiện tại có các yếu tố nguy cơ của hội chứng chuyển hóa (Sơ đồ 1) kèm theo [12]:…”