Materiały źródłowe

• #1 Nonalcoholic Fatty Liver Disease: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0701/p35.html/1000

  Nonalcoholic fatty liver disease is characterized by excessive fat accumulation in the liver (hepatic steatosis). […] The diagnosis is usually made after an incidental discovery of unexplained elevation of liver enzyme levels or when steatosis is noted on imaging (e.g., ultrasonography). […] No single laboratory test is diagnostic, but tests of liver function, tests for metabolic syndrome, and tests to exclude other causes of abnormal liver enzyme levels are routinely performed. […] Liver biopsy remains the criterion standard for the diagnosis of nonalcoholic steatohepatitis. […] Screening for nonalcoholic fatty liver disease is not recommended in the general population. […] Patients with nonalcoholic fatty liver disease should be evaluated for metabolic syndrome and insulin resistance.

• #1 Nonalcoholic fatty liver disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/diagnosis-treatment/drc-20354573

  Because NAFLD typically causes no symptoms, it is often found when tests done for other reasons point to a liver problem. For example, a blood test done during a yearly exam may show high levels of liver enzymes, which can lead to more testing and a NAFLD diagnosis. […] Tests done to diagnosis NAFLD, rule out other diseases and see how bad liver damage is include: […] Imaging tests used to diagnose NAFLD include: […] If other tests show signs of more-advanced liver disease or NASH, or if your test results are unclear, your doctor may suggest a liver biopsy. Liver biopsy is the best way to diagnose NASH and clearly shows the amount of liver damage. […] Your doctor is likely to ask you a number of questions, such as: Have you had any symptoms, such as yellowing of the eyes or skin and pain or swelling around your waist? […] If your doctor suspects a liver problem, such as nonalcoholic fatty liver disease, you may be referred to a doctor who specializes in the liver, called a hepatologist.

• #1 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  Non-alcoholic fatty liver disease (NAFLD) is now the commonest cause of abnormal liver function tests (LFTs) in the UK with approximately a third of the population being affected. […] Many patients with NAFLD remain undiagnosed, and recognising those at risk is the first step. […] Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, the majority of patients can be effectively diagnosed non-invasively with tests that are routinely available in the clinic today. […] A diagnosis of NAFLD requires that there is evidence of hepatic steatosis on imaging or histology, and other causes of liver disease or steatosis have been excluded. […] NAFLD is usually asymptomatic, so diagnosis usually follows the incidental finding of abnormal liver enzymes or steatosis on imaging.

• #1 Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00980-1

  NAFLD managements US guidelines define NAFLD as steatosis with 5% fat infiltration in imaging or histology and b) no alcohol, drug, or viral-induced steatosis. NAFLD patients may present with elevated liver enzymes. […] The liver biopsy is the Gold standard for diagnosis of NASH or NAFLD. Performing a liver biopsy on every patient with suspected NAFLD remains controversial. The general indications for performing a liver biopsy in patients with NAFLD confirm or exclude the diagnosis. […] The NAFLD Activity Score (NAS) is a validated score that is used to grade disease activity in patients with NAFLD.

• #1 Diagnosis of NAFLD & NASH – NIDDK

  https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/diagnosis

  Doctors use your medical history, a physical exam, and tests to diagnose nonalcoholic fatty liver disease, or NAFLD (also referred to as metabolic dysfunction-associated steatotic liver disease, or MASLD). […] Your doctor will ask if you have a history of health conditions that make you more likely to develop NAFLD. […] During a physical exam, a doctor usually examines your body and checks your weight and height to calculate your body mass index. […] Doctors use blood tests, imaging tests, and sometimes liver biopsy to diagnose NAFLD and to tell the difference between NAFL and NASH. […] Your doctor may suspect you have NAFLD if your blood test shows increased levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST). […] Routine imaging tests can show fat in your liver. […] Liver biopsy is the only test that can prove a diagnosis of NASH and show clearly how severe the disease is.

• #1 NASH Diagnosis: Testing Methods & Procedures

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-diagnosis/

  How does my doctor determine if I have NAFLD or NASH? […] Because most people with NAFLD have no symptoms and screening for it is not recommended at this time, fatty liver disease is often discovered during a routine blood test or screening for another medical condition. […] Your doctor will use a variety of methods to determine if you have fatty liver disease. […] As part of the medical history, your doctor will ask: […] About your alcohol use, to determine whether the fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver disease. […] During the physical exam, your doctor will: […] Examine your body looking for signs of NAFLD or NASH such as an enlarged liver or yellowing of your skin and whites of your eyes (jaundice). […] The following blood tests will be included as part of your medical evaluation.

• #1 Non-Alcoholic Fatty Liver Disease (NAFLD): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/liver-diseases/fatty-liver-disease-non-alcoholic/treatment

  How is NAFLD Diagnosed? […] NAFLD may be identified from a routine medical test or evaluation for other conditions. The first signs may be elevated liver enzymes or fat in the liver seen on an ultrasound. Your doctor can order blood tests to look for other causes of liver disease. In addition, your doctor will assess your medical history, conduct a physical exam, and order tests. […] Blood tests may indicate that there is fat +/- inflammation in the liver. Many patients with NAFLD may have mild to moderate elevations in liver enzymes (alanine aminotransferase test ALT and aspartate aminotransferase test AST). […] If liver enzymes are elevated, your doctor may order additional tests to find the cause of the inflammation and diagnose non-alcoholic fatty liver disease. […] Your doctor may perform a liver biopsy to determine the severity of fatty liver disease. […] A piece of liver tissue is removed for examination during a liver biopsy. This is usually an outpatient procedure using a local anesthetic to lessen pain.

• #1 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  If abnormal LFTs are present, this is usually mildly raised transaminases (ALT aspartate transaminase (AST)) and/or gamma-glutamyltransferase. […] However, 80% of patients have normal-range ALT levels (males 40IU/L and females 31IU/L), and even if elevated, the ALT typically falls (and AST may rise) as fibrosis progresses to cirrhosis. […] It has been repeatedly shown that 70-80% of subjects with central obesity and 50-80% of patients with type 2 diabetes have evidence of NAFLD on imaging. […] Therefore, a new approach is needed to use metabolic risk factors to identify subjects with NAFLD/NASH rather than relying on liver enzyme abnormalities. […] The NAFLD Liver Fat Score is calculated using the presence of the metabolic syndrome, type 2 diabetes, fasting serum insulin, fasting serum AST and the AST/ALT ratio (AAR).

• #1 NASH/NAFLD: Screening and Diagnostic Testing | Labcorp

  https://www.labcorp.com/nashnafld-screening-and-diagnostic-testing

  No single test can be used to diagnose NAFLD or NASH. The diagnosis is established through a combination of the following tests: […] Increased ALT and AST levels suggest liver inflammation. However, these enzymes do not reveal the extent of scarring and liver damage. […] A liver biopsy is the gold standard test for telling apart NASH from NAFLD. It is an invasive procedure recommended only if your other test results suggest more serious liver disease. […] Liver biopsy results showing fat deposition but no inflammation or cell damage suggest a NAFLD diagnosis. If fat is found along with inflammation and cell damage, your doctor will establish the diagnosis of NASH.

• #1 Diagnosis of NAFLD – Non-Alcoholic Fatty Liver Disease – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK384715/

  Historically, the presence of NAFLD has been suspected in those presenting with abnormal liver blood tests or evidence of fatty changes on ultrasound. […] However, the full spectrum of NAFLD (from simple steatosis to steatohepatitis, cirrhosis and liver-related morbidity) can also be present with normal liver tests. […] Early detection of NAFLD may be useful to identify those with potentially silent progressive fatty liver disease. […] Diagnostic practice varies widely and includes clinical, biochemical and radiographic tests. […] Currently, liver biopsy remains the gold standard for NAFLD diagnosis but it is impractical as a diagnostic tool because it is invasive and expensive. […] As such, there is a need for highly sensitive and specific diagnostic tests that can be commonly used by clinicians in primary, secondary and tertiary care.

• #1 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  9. High serum titers of autoantibodies in association with other features suggestive of autoimmune liver disease (very high aminotransferases, high globulin) should prompt a more complete work-up for autoimmune liver disease. […] 10. As the metabolic syndrome predicts the presence of steatohepatitis in patients with NAFLD, its presence can be used to target patients for a liver biopsy. […] 11. NAFLD Fibrosis Score is a clinically useful tool for identifying NAFLD patients with higher likelihood of having bridging fibrosis and/or cirrhosis. […] 12. Although serum/plasma CK18 is a promising biomarker for identifying steatohepatitis, it is premature to recommend in routine clinical practice. […] 13. Liver biopsy should be considered in patients with NAFLD who are at increased risk to have steatohepatitis and advanced fibrosis.

• #1 Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease – Altamirano – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5631/html

  Although there is a need for development of more accurate NIALD biomarkers to assess fibrosis staging and other features of liver disease (i.e., steatosis, NASH, alcoholic hepatitis), multiple blood-based and imaging-based biomarkers have been developed and validated in NAFLD and ALD, both cross-sectionally against liver biopsy and longitudinally against clinical outcomes. […] Thus, identification of fibrosis and features of NASH including steatosis is essential to identify patients requiring specific treatment and/or closer monitoring due to associated risk for progressive liver disease. […] The most frequently used biomarkers in clinical practice are summarized in Table 1, and their characteristics are explained below. […] The NAFLD Fibrosis Score (NFS) incorporates age, hyperglycemia, BMI, platelet count, serum albumin, and AST/ALT ratio, and in the pivotal study had AUC of 0.88 (0.850.92) and NPV of 93% to exclude F3-F4 fibrosis at NFS 1.455.

• #1 Recent advances in non-invasive diagnosis and medical management of non-alcoholic fatty liver disease in adult | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-020-00043-x

  Liver biopsy is the gold standard test for diagnosis, grading, and histological assessment of NAFLD, and a four-point histopathologic grading system is used to assess severity of steatosis that ranges from 0 to 3, depending on presence of the percentage of fat-containing hepatocytes. […] Before considering the diagnosis of NAFLD, alcoholic fatty liver has to be excluded. […] There is no single laboratory marker that can be used for the diagnosis of NAFLD. […] NAFLD liver fat score (NLFS): The NAFLD liver fat score is estimated by using the presence of the metabolic syndrome, type 2 diabetes, fasting serum insulin level, fasting serum AST, and the AST/ALT ratio. […] Fatty liver index (FLI): Fatty liver index is a suitable and simple predictor for hepatic steatosis. […] Hepatic steatosis index (HSI): It is a simple, effective NAFLD screening tool derived by a logistic regression model.

• #1 Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease

  https://www.mdpi.com/1422-0067/24/3/2844

  Although simple steatosis cases have relatively low odds of developing NAFLD, early diagnosis may help apply appropriate prevention tools to prevent advanced liver diseases. […] Therefore, simple and reproducible biomarkers and scoring systems are needed for hepatic steatosis diagnosis. […] Here we will discuss the current diagnostic methods for NAFLD. […] The FLI represents a noninvasive and well-predictive algorithm for the estimation of hepatic steatosis, which is broadly utilized clinically because of simplicity. […] The NLFS was developed based on proton magnetic resonance spectroscopy (H-MRS) to predict NAFLD and measure liver fat content as a reference standard for hepatic steatosis. […] The LAP was designed for identifying fatty liver disease and determining cardiovascular risk, separating patients with no, intermediate and severe fatty liver using ultrasound images.

• #1 Recent advances in non-invasive diagnosis and medical management of non-alcoholic fatty liver disease in adult | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-020-00043-x

  Lipid accumulation product (LAP): It is significantly associated with the presence of liver steatosis and has a high diagnostic accuracy to identify NAFLD in the general population, and diagnostic accuracy is higher in young age group individuals. […] SteatoTest: SteatoTest includes ten components such as serum 2-macroglobulin, apo A1, haptoglobin, total bilirubin, GGT, ALT, body mass index, serum cholesterol, triglycerides, and glucose adjusted for age and gender. […] NASH can progress to cirrhosis and its complications such as portal hypertension, liver failure, and hepatocellular carcinoma. […] Though liver biopsy is the gold standard test to detect NAFLD and to identify different stages of hepatic steatosis and fibrosis, multiple non-invasive tests are also available nowadays.

• #1 Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease – Altamirano – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5631/html

  Fibrosis-4 (FIB-4) uses age, AST, ALT and platelet count, and in the pivotal study on 832 biopsied patients with HIV and HCV coinfection, a cut off 3.25 had positive predictive value (PPV) of 68% and specificity of 97% in the diagnosis of advanced fibrosis. […] The utility of APRI among NAFLD patients was validated with respective AUROC of 0.77 and 0.91 at cut-off scores 0.431.5 and 0.542.0 respectively. […] BARD Score is the weighted sum of three variables (BMI 28 = 1 point, AST/ALT ratio 0.8 = 2 points, Diabetes = 1 point). […] FibroTest (FT) (or FibroSURE in the United States), uses total bilirubin, gamma glutamyl transferase (GGT), 2-macroglobulin, apolipoprotein A1, and haptoglobin, corrected for age and gender. […] Enhanced liver fibrosis (ELF) is a score using direct biomarkers including matrix metalloproteinase 1 (tissue inhibitor of matrix metalloproteinase 1), hyaluronic acid, and amino terminal peptide of pro-collagen (P3NP) III, showing an AUROC of 0.90 for distinguishing F3-4 fibrosis.

• #1 Nonalcoholic Fatty Liver Disease: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0701/p35.html/1000

  Ultrasonography is the first-line imaging technique for patients with suspected nonalcoholic fatty liver disease. […] Liver biopsy is the criterion standard for diagnosis and prognosis of nonalcoholic fatty liver disease. […] No single laboratory test is diagnostic for nonalcoholic fatty liver disease. […] Imaging studies assess liver and spleen anatomy, and the presence of hepatic steatosis. […] Noninvasive tests for fibrosis may reduce the need for liver biopsy in patients with nonalcoholic fatty liver disease. […] Liver biopsy should be considered in atypical clinical situations (e.g., patients with normal BMI or highly elevated liver enzyme levels).

• #1 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  Once suspected clinically, fatty infiltration of the liver can be confirmed with imaging. […] Ultrasonography is widely used as a first-line investigation for hepatic steatosis that provides a qualitative assessment of fatty infiltration of the liver. […] Although frequently not required for diagnosis, a liver biopsy is the definitive investigation for NAFLD and provides an assessment of hepatic steatosis, hepatocellular injury, inflammation and fibrosis. […] The presence of hepatocyte ballooning degeneration in association with steatosis is the key histological feature that distinguishes NASH from simple steatosis. […] However, the majority of patients with NAFLD can be diagnosed and staged adequately using non-invasive strategies. […] Knowledge of whether a patient has simple steatosis or NASH is very important prognostically.

• #1 Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease

  https://www.mdpi.com/1422-0067/24/3/2844

  Because liver biopsy has important risks and cannot be applied broadly, identifying novel noninvasive biomarkers for simple steatosis, NASH and fibrosis is very important. […] Currently, non-coding RNA can serve as an emerging non-invasive biomarker for NAFLD detection. […] Routine ultrasonography is broadly utilized for the diagnosis of steatosis, which presents as a typical hyperechoic liver. […] MRI is a non-invasive test that quantitates liver fat amounts with high spatial resolution and no ionizing radiation. […] Currently, the number of drug-related trials (monotherapy and combination) is the largest from the perspective of intervention, especially in terms of phase II trials (IIa, IIa/IIb, IIb).

• #1 Diagnosis of NAFLD – Non-Alcoholic Fatty Liver Disease – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK384715/

  The aim of this review is to objectively evaluate existing invasive and non-invasive tests to accurately diagnose NAFLD in adults, young people and children. […] The outcome will facilitate development of a practical diagnostic pathway. […] Hepatic steatosis at 5% or more is the accepted histological definition of grade 1 steatosis; steatosis at less than 5% is considered normal. […] Steatosis at 30% is the accepted lower limit where steatosis can be detected reliably by ultrasound (currently the most commonly used diagnostic test for fatty liver). […] In addition to the imaging techniques assessed by these guidelines, fatty liver can also be detected using computed tomography (CT). […] Given that fatty liver usually has a benign clinical course and that there are alternative imaging techniques without radiation, it was decided that it would be inappropriate to potentially recommend a technique that would significantly add to the population radiation dose.

• #1 Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease – Altamirano – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5631/html

  The accuracy of all these tests is comparable in the diagnosis of steatosis with AUROC between 0.80 to 0.83. […] In general, these methods are more accurate than their blood-based counterparts, as recently shown in a head-to-head comparison against collagen proportionate area from liver biopsies, but they are less available and/or more costly in clinical practice. […] Transient elastography (TE) or vibration controlled transient elastography is available as a point-of-care tool that is reproducible and easy to operate, and it provides objective staging data interpretable by hepatologists. […] The test result (liver stiffness measurement or LSM) is reported in kilopascal (kPa) units, with cut-off limits available to separate stages of fibrosis in NAFLD. […] TE is 94100% accurate in ruling out F3-F4 at cut-off 8 kPa.

• #1 Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease – Altamirano – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5631/html

  The AUROC for diagnosis of advanced fibrosis and cirrhosis does not differ comparing M- vs. XL-probe, although some authors have reported lower cut-off values when using the XL-probe. […] TE combined with FIB-4 can improve the accuracy for diagnosis of advanced fibrosis or cirrhosis and reduce the need for liver biopsy, especially for patients when either of the two tests shows indeterminate results. […] Controlled attenuation parameter (CAP) is a novel ultrasound-based technique able to quantify steatosis incorporated into the TE equipment. […] MRI proton-density fat fraction (PDFF) depends on the ability of MRI technique to separate water and fat signals in any tissue including liver parenchyma, based on chemical-shift encoded MRI. […] MRI-PDFF is a reliable biomarker of hepatic steatosis, quantifying fat in the liver, and following patients on treatment for assessment of efficacy.

• #1 Fatty Liver | Liver Fibrosis – Diagnosis and Treatment

  https://www.radiologyinfo.org/en/info/fatty-liver-disease

  Your doctor will conduct a physical exam and may order blood tests to evaluate your liver function. […] In order to diagnose FLD and liver fibrosis, your doctor may order blood tests to evaluate liver function, including tests to assess the level of the liver enzymes ALT and AST, which can be high when the liver is fatty. […] Your doctor may also order imaging tests of the liver such as: […] Ultrasound elastography is a special ultrasound technique to test for liver fibrosis. […] MR elastography (MRE) is a special MRI technique to test for liver fibrosis. […] Liver biopsy is an image-guided procedure that removes a small sample of liver tissue using a needle. The sample is then examined under a microscope for signs of steatosis, inflammation and damage, and fibrosis. […] Treatment for FLD and liver fibrosis varies depending on the cause. […] For example, therapies for NAFLD may include:

• #1 Diagnosis of NAFLD – Non-Alcoholic Fatty Liver Disease – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK384715/

  On this basis, CT was not formally evaluated as a technique for the detection or quantification of fat within the liver; this is consistent with the principles of the European Committee of Radiation Risk. […] Papers reported diagnostic accuracy for a variety of tests; controlled attenuation parameter (CAP), fatty liver index (FLI), magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), NAFLD liver fat score, SteatoTest and ultrasound, using multiple different thresholds. […] The GDG concluded that the identified studies provided evidence for all 4 of the imaging techniques under review (CAP, MRI, MRS and abdominal ultrasound) as being sufficiently effective tests for detecting both greater than or equal to 5% and greater than or equal to 30% steatosis in adults. […] The opinion of the GDG was that MRI and MRS appeared to be the most accurate imaging techniques for diagnosing NAFLD in adults.

• #1 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  14. The presence of metabolic syndrome and the NAFLD Fibrosis Score may be used for identifying patients who are at risk for steatohepatitis and advanced fibrosis. […] 15. Liver biopsy should be considered in patients with suspected NAFLD in whom competing etiologies for hepatic steatosis and co-existing chronic liver diseases cannot be excluded without a liver biopsy. […] 16. Weight loss generally reduces hepatic steatosis, achieved either by hypocaloric diet alone or in conjunction with increased physical activity. […] 17. Loss of at least 3-5% of body weight appears necessary to improve steatosis, but a greater weight loss (up to 10%) may be needed to improve necroinflammation. […] 18. Exercise alone in adults with NAFLD may reduce hepatic steatosis but its ability to improve other aspects of liver histology remains unknown.

• #1 Non-Alcoholic Fatty Liver Disease: Diagnosis and Evaluation of Disease Severity

  https://brieflands.com/articles/thrita-18174

  In view of the limitations of the above-mentioned modalities, liver biopsy remains the gold standard method for documentation of diagnosis and estimation of disease severity in NAFLD. […] The documentation of diagnosis is the first step in the management of these patients. NAFLD is yet a diagnosis of exclusion. Diagnosis is based on the patient history, physical examination, laboratory findings, and imaging studies. […] Liver biopsy is already considered as the gold standard method to diagnose and evaluate the extent of liver parenchymal damage in NAFLD. […] Liver biopsy is already considered the gold standard method for the diagnosis of NAFLD. It is used when definitive clinical and laboratory findings are absent for ruling out the other causes of chronic hepatitis. […] Liver biopsy is not necessary for the diagnosis of NAFLD when the clinical and paraclinical findings are apparently in favor of NAFLD diagnosis and other causes are excluded. The typical histological findings in NAFLD are shown in Table 5. Clinical findings, imaging studies and laboratory investigations have limitations for predicting the severity of disease. Liver biopsy is already considered as the method of choice for evaluation the extent of steatosis, inflammation, and fibrosis in NAFLD. However, the possible risks and invasiveness have limited its use in common practice.

• #1 Practical Diagnosis and Staging of Nonalcoholic Fatty Liver Disease: A Narrative Review – European Medical Journal

  https://www.emjreviews.com/hepatology/article/practical-diagnosis-and-staging-of-nonalcoholic-fatty-liver-disease-a-narrative-review/

  Most individuals with NAFLD are asymptomatic and present incidentally with raised liver enzymes or evidence of steatosis on imaging; if symptoms do occur, they include right upper quadrant pain or fatigue. […] Once suspected clinically, the presence of hepatic steatosis should be confirmed on imaging. […] In most cases, NAFLD can be confidently diagnosed without the need for a liver biopsy in individuals with steatosis on imaging or in those with raised liver enzymes and metabolic risk factors, after the exclusion of other causes. […] Once a diagnosis of NAFLD has been made, it is vital to stage the disease to assess prognosis and determine if specific treatment (in addition to lifestyle changes) for NAFLD is required. […] The NFS and FIB-4 scores are the most widely used simple noninvasive scores and are recommended in European guidelines. […] Overall, despite their limitations, the FIB-4 score and NFS offer a good first-line test to stage liver fibrosis and if individuals have a low score (using appropriate age corrected cut-offs), advanced fibrosis can reliably be excluded.

• #1 Metabolic Dysfunction-Associated Steatotic Liver Disease Diagnosis – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/nafl/diagnosis.asp

  The most common chronic liver disease in U.S. affecting 2.7 million Veterans, NAFLD is a leading cause of cirrhosis and hepatocellular carcinoma and a leading indication for liver transplantation. […] Early identification by primary care providers and implementation of lifestyle modifications in patients with evidence of fibrosis progression is critical. […] Patients who are overweight or obese and have persistently elevated ALT or fatty liver on imaging should be evaluated for NAFLD. […] Diabetic patients should have a liver panel every 1-2 years. Patients with an elevated ALT (for 6 months) with no other etiology for liver injury (e.g., medications, viral hepatitis B or C, hemochromatosis, etc.) should be assessed for fibrosis risk using an online Fibrosis-4 score (FIB-4) calculator.

• #1 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) […] Preferred approaches to the diagnostic, therapeutic and preventive aspects for the care of patients with non-alcoholic fatty liver disease. […] 1. Ongoing or recent alcohol consumption > 21 drinks on average per week in men and > 14 drinks on average per week in women is a reasonable definition for significant alcohol consumption when evaluating patients with suspected nonalcoholic fatty liver disease (NAFLD) in clinical practice. […] 2. When patients with unsuspected hepatic steatosis detected on imaging have symptoms or signs attributable to liver disease or have abnormal liver biochemistries, they should be evaluated as though they have suspected NAFLD and worked-up accordingly. […] 3. In patients with unsuspected hepatic steatosis detected on imaging who lack any liver-related symptoms or signs and have normal liver biochemistries, it is reasonable to assess for metabolic risk factors (e.g., obesity, glucose intolerance, dyslipidemia) and alternate causes for hepatic steatosis such as significant alcohol consumption or medications.

• #1 Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease – Altamirano – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5631/html

  Fibrosis plays a central role in prognosticating NAFLD, whereas steatosis has an inverse association with fibrosis and thus its prognostic role is limited to early stages of the disease. […] Thus, our algorithm starts with fibrosis classification and then adds CAP or PDFF to help identify NAFLD, under the assumption that other causes of hepatic steatosis have already been ruled out. […] The presence of F2 with steatosis or F3 (advanced fibrosis) without steatosis calls for a liver biopsy, although in patients who are reluctant to undergo this procedure starting treatment is a reasonable option. […] Finally, patients with F3 and steatosis or F4 (cirrhosis) should not be delayed for treatment and appropriate screening. […] In NAFLD patients in need of a surgical procedure (liver resection or bariatric) a similar finding would preclude surgery due to the presence of clinically significant portal hypertension. […] In summary, kinetics of LSM and CAP may be useful methods for monitoring alcohol abuse and relapse in patients with ALD.

• #1 MASLD, NAFLD and fatty liver disease – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/masld-nafld-and-fatty-liver-disease/

  If your doctor thinks you have any form of liver disease they will try to find out what is causing it and how damaged your liver is. Doctors use a range of tests to get different information and build up an overall picture of what is happening. […] MASLD and NAFLD might only be diagnosed when they have become serious. Or you might be diagnosed after having tests for another health problem. […] The new name MASLD stands for metabolic dysfunction-associated steatotic liver disease. […] The old name NAFLD stands for non-alcohol related fatty liver disease. […] There are currently no medicines available in the UK to specifically treat MASLD. But there is a lot of research being done to develop some. […] Treatment for fatty liver disease (MASLD or NAFLD) has 2 main aims: To stop the condition getting worse, so that it does not lead to liver cancer or liver failure. To help your liver repair as much of the damage as possible.

• #1 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  The sequential algorithm and risk prediction charts we developed and validated represent a significant progress for the patient management in clinical practice. As they use the same fibrosis tests and sequence of tests use, these tools represent an extension and improvement of the current guidelines.

• #1 Fatty liver disease A practical guide for GPs

  https://www.racgp.org.au/afp/2013/july/fatty-liver-disease

  Confirming hepatic fatty infiltration using ultrasound is important. […] The risk of fibrosis and progressive liver disease in NAFLD increases with severity of insulin resistance. […] Staging liver disease and detecting cirrhosis is the most important aspect of assessing fatty liver disease. […] Non-invasive tools for estimating the degree of fibrosis include transient elastography (FibroScan), acoustic radiation force impulse (ARFI), and non-invasive biomarker algorithms such as NAFLD Fibrosis Score, FibroTest and Hepascore. […] The cornerstone to managing NAFLD is achieving weight control and reduction in cardiovascular risk factors such as smoking, diabetes, hypertension and dyslipidaemia. […] Weight reduction via caloric restriction and regular exercise are important, and no medications can currently be recommended as specific therapy. […] General practitioners are vital in identifying patients at risk of NAFLD, and encouraging initiation and maintenance of appropriate lifestyle changes.

• #1 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  23. Ursodeoxycholic acid (UDCA) is not recommended for the treatment of NAFLD or NASH. […] 24. It is premature to recommend omega-3 fatty acids for the specific treatment of NAFLD or NASH but they may be considered as the first line agents to treat hypertriglyceridemia in patients with NAFLD. […] 25. Foregut bariatric surgery is not contraindicated in otherwise eligible obese individuals with NAFLD or NASH (but without established cirrhosis). […] 26. The type, safety and efficacy of foregut bariatric surgery in otherwise eligible obese individuals with established cirrhosis due to NAFLD are not established. […] 27. It is premature to consider foregut bariatric surgery as an established option to specifically treat NASH. […] 28. Patients with NAFLD should not consume heavy amounts of alcohol.

• #1 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  34. Patients with NASH cirrhosis should be screened for gastroesophageal varices according to the American Association for the Study of Liver Diseases (AASLD)/American College of Gastroenterology (ACG) practice guidelines. […] 35. Patients with NASH cirrhosis should be considered for HCC screening according to the AASLD/ACG practice guidelines. […] 36. Current evidence does not support routinely repeating a liver biopsy in patients with NAFL or NASH. […] 37. Children with fatty liver who are very young or not overweight should be tested for monogenic causes of chronic liver disease such as fatty acid oxidation defects, lysosomal storage diseases and peroxisomal disorders, in addition to those causes considered for adults. […] 38. Low serum titers of autoantibodies are often present in children with NAFLD, but higher titers, particularly in association with higher serum aminotransferases and high globulin should prompt a liver biopsy to evaluate for possible autoimmune hepatitis.

• #1 Diagnostic Modalities of Non-Alcoholic Fatty Liver Disease: From Biochemical Biomarkers to Multi-Omics Non-Invasive Approaches

  https://www.mdpi.com/2075-4418/12/2/407

  Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the most common cause of chronic liver disease worldwide, and its prevalence is increasing globally. […] To date, liver biopsy remains the gold standard procedure for the diagnosis of NASH and staging of NAFLD. […] However, due to its invasive nature, research on non-invasive tests is rapidly increasing with significant advances having been achieved during the last decades in the diagnostic field. […] For the diagnosis of NAFLD, the ultrasound remains the first-line modality, despite being less reliable if HS is <20%. [...] There is a recognised ongoing need for a non-invasive tool that could accurately identify NASH and also discern low- and high-risk individuals for advanced fibrosis, as high-risk patients would need closer surveillance and management.

• #1 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  Unfortunately there is no widely available simple blood test or imaging modality that can differentiate simple steatosis from NASH. […] The search for an accurate biomarker of NASH is an active area of clinical research, and there have been some recent advances. […] Staging fibrosis is essential in all patients with NAFLD to identify subjects with advanced fibrosis who are at risk of liver-related complications. […] These tests provide an indirect measure of fibrosis and are potentially appealing non-invasive markers of fibrosis as they are inexpensive and are performed in all patients with liver disease. […] Fibrotic livers have reduced elasticity due to the deposition of fibrous tissue in the hepatic parenchyma. […] The LSM correlates well with the degree of hepatic fibrosis in a range of liver diseases, including NAFLD. […] NAFLD is a very common condition affecting approximately 30% of the population and can cause significant liver disease in a proportion of patients. Accurate diagnosis and staging is important in determining the appropriate long-term management for patients with NAFLD.

• #1 Laboratory diagnostics of non-alcoholic fatty liver disease

  https://www.degruyter.com/document/doi/10.1515/labmed-2014-0026/html?lang=en

  Owing to the high prevalence and associated complications of liver fibrosis, of any etiology, and nonalcoholic fatty liver disease (NAFLD), both have become important public health issues. Liver biopsy is considered the gold standard for diagnosis and staging of liver fibrosis, as well as NAFLD. Recent studies have discovered and validated several non-invasive biochemical biomarkers and imaging procedures for the diagnostics of liver fibrosis and NAFLD. […] Cytokeratin 18 (CK-18) is the most promising single biomarker for the diagnosis of non-alcoholic steatohepatitis (NASH). […] In conclusion, non-invasive biomarkers and elastography appear promising as prescreening tools to limit the number of liver biopsies. […] The diagnosis of NAFLD requires firstly the detection of steatosis by means of histology or imaging, and secondly the exclusion of causes of secondary fatty liver such as excessive drinking, the taking of steatogenic drugs or hereditary storage diseases.

• #1 Diagnostic Modalities of Non-Alcoholic Fatty Liver Disease: From Biochemical Biomarkers to Multi-Omics Non-Invasive Approaches

  https://www.mdpi.com/2075-4418/12/2/407

  Current guidelines recommend against systematic screening for NAFLD in the general population. […] However, screening in high-risk groups, such as patients with metabolic disorders (T2DM, obesity, hypertension, dyslipidaemia), is still open for debate. […] The present review article provides a comprehensive overview of the currently available and emerging non-invasive diagnostic tools used in assessing NAFLD, also highlighting the importance of accurate and validated diagnostic tools.

• #1 Multiparametric MR Index for the Diagnosis of Non-Alcoholic Steatohepatitis in Patients with Non-Alcoholic Fatty Liver Disease | Scientific Reports

  https://www.nature.com/articles/s41598-020-59601-3

  Non-alcoholic steatohepatitis (NASH) is a complex disease consisting of various components including steatosis, lobular inflammation, and ballooning degeneration, with or without fibrosis. […] This study was aimed to evaluate the feasibility of magnetic resonance imaging (MRI) for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in non-alcoholic fatty liver disease (NAFLD) patients. […] Liver biopsy is regarded as the gold standard for the diagnosis of NASH. […] Therefore, there have been substantial clinical demands for alternative and noninvasive methods to diagnose NASH. […] With recent advances in MRI, MR spectroscopy (MRS), and MR elastography (MRE) have emerged as promising methods for detecting and grading fat and fibrosis, respectively.

• #1 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  Unlike for advanced liver fibrosis, the practical rules for the early non-invasive diagnosis of cirrhosis in NAFLD remain not well defined. Here, we report the derivation and validation of a stepwise diagnostic algorithm in 1568 patients with NAFLD and liver biopsy coming from four independent cohorts. The study algorithm, using first the elastography-based tests Agile3+ and Agile4 and then the specialized blood tests FibroMeterV3G and CirrhoMeterV3G, provides stratification in four groups, the last of which is enriched in cirrhosis (71% prevalence in the validation set). A risk prediction chart is also derived to allow estimation of the individual probability of cirrhosis. The predicted risk shows excellent calibration in the validation set, and mean difference with perfect prediction is only 2.9%. These tools improve the personalized non-invasive diagnosis of cirrhosis in NAFLD.

• #1 Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-non-invasive-diagnosis-non-alcoholic-fatty-liver-S1665268120301794

  Non-Alcoholic Fatty Liver Disease (NAFLD) is a metabolic liver disease related to insulin resistance, which requires invasive methods for diagnosis. The aim of this study was to analyze whether the use of an algorithm involving both clinical indices and hepatic ultrasound measurements improves the accuracy for the non-invasive diagnosis of NAFLD. […] Liver biopsy is the current clinical gold standard for assessing liver fat content, in which presence of steatosis, hepatocellular injury in the form of ballooning, lobular inflammation and perisinusoidal fibrosis, usually with a zone 3 distribution are considered to be most important histological features of adult NAFLD. However, this method is invasive and subject to sampling errors, being not optimal for screening, monitoring, and clinical decision-making. Noninvasive methods that accurately and objectively quantify liver fat are needed. In that context, Clinical Indexes and Doppler Hepatic ultrasound have been recently proposed as alternative methods for non-invasively diagnosing NAFLD.

• #1 Diagnostic Modalities of Non-Alcoholic Fatty Liver Disease: From Biochemical Biomarkers to Multi-Omics Non-Invasive Approaches

  https://www.mdpi.com/2075-4418/12/2/407

  The present study aims to provide a comprehensive review of the non-invasive diagnostic tools used in the assessment of NAFLD, ranging from biochemical markers and imaging modalities to multi-omics approaches. […] The high volumes of patients with NAFLD have necessitated the consideration of a traffic light system and flow-charts to prognosticate clinical outcomes and fashion care plans for patients. […] The growing clinical consequences of NAFLD are leading to an increased economic burden worldwide. […] The global prevalence of NAFLD is estimated at 24%, whilst NASH affects approximately 1.5% to 6.5% of adults worldwide. […] Early recognition and intervention are vital to improve clinical outcomes and reduce the economic and health burden of NAFLD. […] The most common cause of death in NAFLD patients is cardiovascular disease (CVD), whilst liver-related mortality takes third place after cancer.

• #1 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  19. Metformin has no significant effect on liver histology and is not recommended as a specific treatment for liver disease in adults with nonalcoholic steatohepatitis (NASH). […] 20. Pioglitazone can be used to treat steatohepatitis in patients with biopsy-proven NASH. However, it should be noted that majority of the patients who participated in clinical trials that investigated pioglitazone for NASH were non-diabetic and that long term safety and efficacy of pioglitazone in patients with NASH is not established. […] 21. Vitamin E (α-tocopherol) administered at daily dose of 800 IU/day improves liver histology in non-diabetic adults with biopsy-proven NASH and therefore it should be considered as a first-line pharmacotherapy for this patient population. […] 22. Until further data supporting its effectiveness become available, vitamin E is not recommended to treat NASH in diabetic patients, NAFLD without liver biopsy, NASH cirrhosis or cryptogenic cirrhosis.

• #1 Non-alcoholic fatty liver disease (NAFLD)

  https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/

  NAFLD is often diagnosed after a blood test called a liver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. […] But blood tests do not always pick up NAFLD. […] The condition may also be spotted during an ultrasound scan of your tummy. […] If you’re diagnosed with NAFLD, further tests may be needed to determine which stage you have. This may involve a special blood test or having another type of ultrasound scan (Fibroscan). […] Some people may also need a biopsy, where a small sample of liver tissue is taken using a needle so it can be analysed in a laboratory. […] Children and young people with an increased risk of NAFLD (those with type 2 diabetes or metabolic syndrome) should have an ultrasound scan of their liver every 3 years. […] Other tests you may have include a CT scan or MRI scan.

• #1 Nonalcoholic Fatty Liver Disease (NAFLD)

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/

  Nonalcoholic fatty liver disease (NAFLD), now called metabolic dysfunction-associated steatotic liver disease (MASLD), is the buildup of extra fat in liver cells that is not caused by alcohol. […] Nonalcoholic fatty liver disease (now known as MASLD) tends to develop in people who are overweight or obese or have diabetes, high cholesterol, or high triglycerides. […] Current medical recommendations suggest the importance of discussing the NAFLD/heart disease connection with a health care provider if you have NAFLD. […] Nonalcoholic fatty liver disease (now called MASLD) can get worse and cause liver inflammation (enlargement or swelling) and damage called nonalcoholic steatohepatitis (NASH, which has been renamed MASH). […] Nonalcoholic fatty liver disease (now called MASLD) may be suspected if blood tests show higher than normal levels of liver enzymes.

• #2 Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1103-x

  Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. It affects an estimated 20% of the general population, based on cohort studies of varying size and heterogeneous selection. However, the prevalence and incidence of recorded NAFLD diagnoses in unselected real-world health-care records is unknown. […] In the largest primary-care record study of its kind to date, rates of recorded NAFLD are much lower than expected suggesting under-diagnosis and under-recording. Despite this, we have identified rising incidence and prevalence of the diagnosis. Improved recognition of NAFLD may identify people who will benefit from risk factor modification or emerging therapies to prevent progression to cardiometabolic and hepatic complications. […] A pragmatic approach is to focus on real-world patients for whom the diagnosis of NAFLD has been made during routine clinical care. A diagnosis of NAFLD is often made following abnormal imaging of the liver or elevated serum liver enzymes (so-called liver function tests) and involves exclusion of other causes of liver injury, such as excess alcohol consumption and viral hepatitis.

• #2 NASH Diagnosis: Testing Methods & Procedures

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-diagnosis/

  How does my doctor determine if I have NAFLD or NASH? […] Because most people with NAFLD have no symptoms and screening for it is not recommended at this time, fatty liver disease is often discovered during a routine blood test or screening for another medical condition. […] Your doctor will use a variety of methods to determine if you have fatty liver disease. […] As part of the medical history, your doctor will ask: […] About your alcohol use, to determine whether the fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver disease. […] During the physical exam, your doctor will: […] Examine your body looking for signs of NAFLD or NASH such as an enlarged liver or yellowing of your skin and whites of your eyes (jaundice). […] The following blood tests will be included as part of your medical evaluation.

• #2 Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00980-1

  Given the increasing prevalence of diabetes and obesity worldwide, the deleterious effects of non-alcoholic fatty liver disease (NAFLD) are becoming a growing challenge for public health. […] In these patients, advanced fibrosis is the major predictor of morbidity and liver-related mortality, and an accurate diagnosis of NASH and NAFLD is mandatory. Histologic evaluation with liver biopsy remains the gold standard to diagnose NAFLD. Diagnosis of NAFLD is defined as presence of hepatic steatosis, ballooning and lobular inflammation with or without fibrosis. […] In terms of diagnostic tests, the gold standard to investigate any form of liver inflammation e.g. damage is a liver biopsy. In the diagnosis of NAFLD and related disorders, liver biopsies can be extremely helpful and its findings can range from triglyceride deposition as droplets in the hepatocyte to more extensive forms of non-alcoholic steatohepatitis (NASH).

• #2 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) […] Preferred approaches to the diagnostic, therapeutic and preventive aspects for the care of patients with non-alcoholic fatty liver disease. […] 1. Ongoing or recent alcohol consumption > 21 drinks on average per week in men and > 14 drinks on average per week in women is a reasonable definition for significant alcohol consumption when evaluating patients with suspected nonalcoholic fatty liver disease (NAFLD) in clinical practice. […] 2. When patients with unsuspected hepatic steatosis detected on imaging have symptoms or signs attributable to liver disease or have abnormal liver biochemistries, they should be evaluated as though they have suspected NAFLD and worked-up accordingly. […] 3. In patients with unsuspected hepatic steatosis detected on imaging who lack any liver-related symptoms or signs and have normal liver biochemistries, it is reasonable to assess for metabolic risk factors (e.g., obesity, glucose intolerance, dyslipidemia) and alternate causes for hepatic steatosis such as significant alcohol consumption or medications.

• #2 Non-Alcoholic Fatty Liver Disease (NAFLD): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/liver-diseases/fatty-liver-disease-non-alcoholic/treatment

  How is NAFLD Diagnosed? […] NAFLD may be identified from a routine medical test or evaluation for other conditions. The first signs may be elevated liver enzymes or fat in the liver seen on an ultrasound. Your doctor can order blood tests to look for other causes of liver disease. In addition, your doctor will assess your medical history, conduct a physical exam, and order tests. […] Blood tests may indicate that there is fat +/- inflammation in the liver. Many patients with NAFLD may have mild to moderate elevations in liver enzymes (alanine aminotransferase test ALT and aspartate aminotransferase test AST). […] If liver enzymes are elevated, your doctor may order additional tests to find the cause of the inflammation and diagnose non-alcoholic fatty liver disease. […] Your doctor may perform a liver biopsy to determine the severity of fatty liver disease. […] A piece of liver tissue is removed for examination during a liver biopsy. This is usually an outpatient procedure using a local anesthetic to lessen pain.

• #2 Diagnosis of NAFLD & NASH – NIDDK

  https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/diagnosis

  Doctors use your medical history, a physical exam, and tests to diagnose nonalcoholic fatty liver disease, or NAFLD (also referred to as metabolic dysfunction-associated steatotic liver disease, or MASLD). […] Your doctor will ask if you have a history of health conditions that make you more likely to develop NAFLD. […] During a physical exam, a doctor usually examines your body and checks your weight and height to calculate your body mass index. […] Doctors use blood tests, imaging tests, and sometimes liver biopsy to diagnose NAFLD and to tell the difference between NAFL and NASH. […] Your doctor may suspect you have NAFLD if your blood test shows increased levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST). […] Routine imaging tests can show fat in your liver. […] Liver biopsy is the only test that can prove a diagnosis of NASH and show clearly how severe the disease is.

• #2 Fatty Liver Disease: Nonalcoholic and Alcoholic Steatohepatitis (NAFLD/AFLD)

  https://www.webmd.com/fatty-liver-disease/fatty-liver-disease

  Fatty liver disease (FLD) means you have extra fat in your liver. You might hear your doctor call it hepatic steatosis. Most of the time, it doesn’t cause symptoms, but over time a buildup of fat makes it harder for your liver to work. […] This type used to be called nonalcoholic fatty liver disease (NAFLD). It is very common in the U.S., affecting 1 in 3 adults. […] The reason why some people with MASLD have simple fatty liver and others get MASH isnt known. […] Because most people dont have symptoms, these conditions arent easy to diagnose. […] Your doctor may use different methods to find out if you have fatty liver disease. Some of the things your doctor may use to diagnose fatty liver disease are: […] Your doctor will ask about your alcohol use. This information can help your doctor tell if you have ALD or MASLD, so be truthful.

• #2 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  If abnormal LFTs are present, this is usually mildly raised transaminases (ALT aspartate transaminase (AST)) and/or gamma-glutamyltransferase. […] However, 80% of patients have normal-range ALT levels (males 40IU/L and females 31IU/L), and even if elevated, the ALT typically falls (and AST may rise) as fibrosis progresses to cirrhosis. […] It has been repeatedly shown that 70-80% of subjects with central obesity and 50-80% of patients with type 2 diabetes have evidence of NAFLD on imaging. […] Therefore, a new approach is needed to use metabolic risk factors to identify subjects with NAFLD/NASH rather than relying on liver enzyme abnormalities. […] The NAFLD Liver Fat Score is calculated using the presence of the metabolic syndrome, type 2 diabetes, fasting serum insulin, fasting serum AST and the AST/ALT ratio (AAR).

• #2 Non-alcoholic fatty liver disease (NAFLD)

  https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/

  NAFLD is often diagnosed after a blood test called a liver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. […] But blood tests do not always pick up NAFLD. […] The condition may also be spotted during an ultrasound scan of your tummy. […] If you’re diagnosed with NAFLD, further tests may be needed to determine which stage you have. This may involve a special blood test or having another type of ultrasound scan (Fibroscan). […] Some people may also need a biopsy, where a small sample of liver tissue is taken using a needle so it can be analysed in a laboratory. […] Children and young people with an increased risk of NAFLD (those with type 2 diabetes or metabolic syndrome) should have an ultrasound scan of their liver every 3 years. […] Other tests you may have include a CT scan or MRI scan.

• #2 Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease – Altamirano – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5631/html

  Fibrosis-4 (FIB-4) uses age, AST, ALT and platelet count, and in the pivotal study on 832 biopsied patients with HIV and HCV coinfection, a cut off 3.25 had positive predictive value (PPV) of 68% and specificity of 97% in the diagnosis of advanced fibrosis. […] The utility of APRI among NAFLD patients was validated with respective AUROC of 0.77 and 0.91 at cut-off scores 0.431.5 and 0.542.0 respectively. […] BARD Score is the weighted sum of three variables (BMI 28 = 1 point, AST/ALT ratio 0.8 = 2 points, Diabetes = 1 point). […] FibroTest (FT) (or FibroSURE in the United States), uses total bilirubin, gamma glutamyl transferase (GGT), 2-macroglobulin, apolipoprotein A1, and haptoglobin, corrected for age and gender. […] Enhanced liver fibrosis (ELF) is a score using direct biomarkers including matrix metalloproteinase 1 (tissue inhibitor of matrix metalloproteinase 1), hyaluronic acid, and amino terminal peptide of pro-collagen (P3NP) III, showing an AUROC of 0.90 for distinguishing F3-4 fibrosis.

• #2 Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease

  https://www.mdpi.com/1422-0067/24/3/2844

  Although simple steatosis cases have relatively low odds of developing NAFLD, early diagnosis may help apply appropriate prevention tools to prevent advanced liver diseases. […] Therefore, simple and reproducible biomarkers and scoring systems are needed for hepatic steatosis diagnosis. […] Here we will discuss the current diagnostic methods for NAFLD. […] The FLI represents a noninvasive and well-predictive algorithm for the estimation of hepatic steatosis, which is broadly utilized clinically because of simplicity. […] The NLFS was developed based on proton magnetic resonance spectroscopy (H-MRS) to predict NAFLD and measure liver fat content as a reference standard for hepatic steatosis. […] The LAP was designed for identifying fatty liver disease and determining cardiovascular risk, separating patients with no, intermediate and severe fatty liver using ultrasound images.

• #2 Recent advances in non-invasive diagnosis and medical management of non-alcoholic fatty liver disease in adult | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-020-00043-x

  Liver biopsy is the gold standard test for diagnosis, grading, and histological assessment of NAFLD, and a four-point histopathologic grading system is used to assess severity of steatosis that ranges from 0 to 3, depending on presence of the percentage of fat-containing hepatocytes. […] Before considering the diagnosis of NAFLD, alcoholic fatty liver has to be excluded. […] There is no single laboratory marker that can be used for the diagnosis of NAFLD. […] NAFLD liver fat score (NLFS): The NAFLD liver fat score is estimated by using the presence of the metabolic syndrome, type 2 diabetes, fasting serum insulin level, fasting serum AST, and the AST/ALT ratio. […] Fatty liver index (FLI): Fatty liver index is a suitable and simple predictor for hepatic steatosis. […] Hepatic steatosis index (HSI): It is a simple, effective NAFLD screening tool derived by a logistic regression model.

• #2 Practical Diagnosis and Staging of Nonalcoholic Fatty Liver Disease: A Narrative Review – European Medical Journal

  https://www.emjreviews.com/hepatology/article/practical-diagnosis-and-staging-of-nonalcoholic-fatty-liver-disease-a-narrative-review/

  Most individuals with NAFLD are asymptomatic and present incidentally with raised liver enzymes or evidence of steatosis on imaging; if symptoms do occur, they include right upper quadrant pain or fatigue. […] Once suspected clinically, the presence of hepatic steatosis should be confirmed on imaging. […] In most cases, NAFLD can be confidently diagnosed without the need for a liver biopsy in individuals with steatosis on imaging or in those with raised liver enzymes and metabolic risk factors, after the exclusion of other causes. […] Once a diagnosis of NAFLD has been made, it is vital to stage the disease to assess prognosis and determine if specific treatment (in addition to lifestyle changes) for NAFLD is required. […] The NFS and FIB-4 scores are the most widely used simple noninvasive scores and are recommended in European guidelines. […] Overall, despite their limitations, the FIB-4 score and NFS offer a good first-line test to stage liver fibrosis and if individuals have a low score (using appropriate age corrected cut-offs), advanced fibrosis can reliably be excluded.

• #2 Fatty Liver Disease: Blood Tests for Diagnosis

  https://www.healthline.com/health/blood-tests-for-fatty-liver

  The specific tests for diagnosing MASLD include: Alanine transaminase (ALT) test, International normalized ratio (INR) test, Albumin test, Complete blood count (CBC), FibroSURE test. […] Typical ALT levels fall between 0 and 35 units per liter (IU/L), though each lab may have a slightly different range. A result outside this range doesnt mean you have MASLD, but it does warrant more investigation via ultrasound (FibroScan, a type of liver ultrasound), MRI, and CT scan. […] Your doctor may also use the results from your ALT along with your age and platelet count to calculate your Fibrosis-4 Index (FIB-4). The FIB-4 score helps indicate how advanced scarring on your liver, known as liver fibrosis, may be. A score over 2.67 in people with MASLD helps predict advanced fibrosis up to 80% of the time.

• #2 Non-alcoholic fatty liver disease and diabetes: diagnosis, assessment and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/non-alcoholic-fatty-liver-disease-and-diabetes-diagnosis-assessment-and-management

  Imaging studies may be used to look for hepatic steatosis, necessary for a diagnosis of NAFLD. […] Ultrasound scanning can identify steatosis and is a relatively low cost, safe and accessible investigation. […] NICE recommends use of the enhanced liver fibrosis (ELF) test as a non-invasive way to help to identify high-risk patients. […] Specific pharmacological treatment for low-risk patients without evidence of fibrosis is generally not indicated owing to the paucity of evidence available and the relatively low likelihood that this population of patients will progress to more serious forms of liver disease. […] It is important to identify such patients because they may warrant referral into specialist secondary care services for further assessment and management.

• #2 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  Once suspected clinically, fatty infiltration of the liver can be confirmed with imaging. […] Ultrasonography is widely used as a first-line investigation for hepatic steatosis that provides a qualitative assessment of fatty infiltration of the liver. […] Although frequently not required for diagnosis, a liver biopsy is the definitive investigation for NAFLD and provides an assessment of hepatic steatosis, hepatocellular injury, inflammation and fibrosis. […] The presence of hepatocyte ballooning degeneration in association with steatosis is the key histological feature that distinguishes NASH from simple steatosis. […] However, the majority of patients with NAFLD can be diagnosed and staged adequately using non-invasive strategies. […] Knowledge of whether a patient has simple steatosis or NASH is very important prognostically.

• #2 Fatty liver disease – Wikipedia

  https://en.wikipedia.org/wiki/Fatty_liver_disease

  Imaging studies are often obtained during the evaluation process. […] Histological diagnosis by liver biopsy is the most accurate measure of fibrosis and liver fat progression as of 2018. […] Conventional imaging methods, such as ultrasound, CT and MRI, are not specific enough to detect fatty liver disease unless fat occupies at least 30% of the liver volume.

• #2 Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease – Altamirano – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5631/html

  The AUROC for diagnosis of advanced fibrosis and cirrhosis does not differ comparing M- vs. XL-probe, although some authors have reported lower cut-off values when using the XL-probe. […] TE combined with FIB-4 can improve the accuracy for diagnosis of advanced fibrosis or cirrhosis and reduce the need for liver biopsy, especially for patients when either of the two tests shows indeterminate results. […] Controlled attenuation parameter (CAP) is a novel ultrasound-based technique able to quantify steatosis incorporated into the TE equipment. […] MRI proton-density fat fraction (PDFF) depends on the ability of MRI technique to separate water and fat signals in any tissue including liver parenchyma, based on chemical-shift encoded MRI. […] MRI-PDFF is a reliable biomarker of hepatic steatosis, quantifying fat in the liver, and following patients on treatment for assessment of efficacy.

• #2 Non-Alcoholic Fatty Liver Disease – Zero To Finals

  https://zerotofinals.com/medicine/gastroenterology/nafld/

  Transient elastography (“FibroScan”) can be used to assess the stiffness of the liver using high-frequency sound waves. […] Liver biopsy may be required to confirm the diagnosis and exclude other causes of liver disease. […] The diagnosis requires the presence of ultrasound findings of a fatty liver, risk factors and excluding other causes of liver disease with a careful alcohol history and full non-invasive liver screen. Liver biopsy is the gold standard test.

• #2

  https://link.springer.com/article/10.1007/s00125-016-3944-1

  Non-alcoholic fatty liver disease (NAFLD) increases risk of mortality from liver and cardiovascular disease (CVD) and is the major cause of hepatocellular carcinoma (HCC), which may develop without cirrhosis. […] The challenge for the diabetologist is to identify patients at risk of advanced liver disease and HCC. At a minimum, liver function tests (LFTs), despite being neither specific nor sensitive, should be performed in all patients with the metabolic syndrome or type 2 diabetes. […] Preferably, evaluation of NAFLD should be based on measurement of steatosis biomarkers or ultrasound if easily available. […] The diagnosis of NAFLD requires that there is evidence of steatosis either by imaging or histology and that there are no secondary causes of steatosis, such as increased alcohol consumption, viral hepatitis, use of steroid medications or other causes.

• #2 Diagnosis of NAFLD – Non-Alcoholic Fatty Liver Disease – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK384715/

  On this basis, CT was not formally evaluated as a technique for the detection or quantification of fat within the liver; this is consistent with the principles of the European Committee of Radiation Risk. […] Papers reported diagnostic accuracy for a variety of tests; controlled attenuation parameter (CAP), fatty liver index (FLI), magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), NAFLD liver fat score, SteatoTest and ultrasound, using multiple different thresholds. […] The GDG concluded that the identified studies provided evidence for all 4 of the imaging techniques under review (CAP, MRI, MRS and abdominal ultrasound) as being sufficiently effective tests for detecting both greater than or equal to 5% and greater than or equal to 30% steatosis in adults. […] The opinion of the GDG was that MRI and MRS appeared to be the most accurate imaging techniques for diagnosing NAFLD in adults.

• #2 Multiparametric MR Index for the Diagnosis of Non-Alcoholic Steatohepatitis in Patients with Non-Alcoholic Fatty Liver Disease | Scientific Reports

  https://www.nature.com/articles/s41598-020-59601-3

  Non-alcoholic steatohepatitis (NASH) is a complex disease consisting of various components including steatosis, lobular inflammation, and ballooning degeneration, with or without fibrosis. […] This study was aimed to evaluate the feasibility of magnetic resonance imaging (MRI) for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in non-alcoholic fatty liver disease (NAFLD) patients. […] Liver biopsy is regarded as the gold standard for the diagnosis of NASH. […] Therefore, there have been substantial clinical demands for alternative and noninvasive methods to diagnose NASH. […] With recent advances in MRI, MR spectroscopy (MRS), and MR elastography (MRE) have emerged as promising methods for detecting and grading fat and fibrosis, respectively.

• #2 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  14. The presence of metabolic syndrome and the NAFLD Fibrosis Score may be used for identifying patients who are at risk for steatohepatitis and advanced fibrosis. […] 15. Liver biopsy should be considered in patients with suspected NAFLD in whom competing etiologies for hepatic steatosis and co-existing chronic liver diseases cannot be excluded without a liver biopsy. […] 16. Weight loss generally reduces hepatic steatosis, achieved either by hypocaloric diet alone or in conjunction with increased physical activity. […] 17. Loss of at least 3-5% of body weight appears necessary to improve steatosis, but a greater weight loss (up to 10%) may be needed to improve necroinflammation. […] 18. Exercise alone in adults with NAFLD may reduce hepatic steatosis but its ability to improve other aspects of liver histology remains unknown.

• #2 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  39. Due to a paucity of evidence, a formal recommendation cannot be made with regards to screening for NAFLD in overweight and obese children despite a recent expert committee recommendation for biannual screening for liver disease with liver enzyme measurements in this population. […] 40. Liver biopsy in children with suspected NAFLD should be performed in those where the diagnosis is unclear, where there is possibility of multiple diagnoses, or before starting therapy with potentially hepatotoxic medications. […] 41. A liver biopsy to establish a diagnosis of NASH should be obtained prior to starting children on pharmacologic therapy for NASH. […] 42. Pathologists interpreting pediatric NAFLD biopsies should recognize the unique pattern frequently found in children to not misidentify pediatric NAFLD.

• #2 NASH Diagnosis: Testing Methods & Procedures

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-diagnosis/

  Liver function tests (LFTs) or liver enzymes These are a group of blood tests that are used to detect, evaluate, and monitor liver disease and damage. […] If your medical evaluation shows no alternative causes for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and imaging studies of your liver show fat and liver stiffness, NASH is suspected. […] If your doctor feels that further confirmation is needed to make a definitive diagnosis of NASH, a liver biopsy may be ordered. […] NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. […] If the tissue shows fat without inflammation and damage, simple fatty liver or NAFLD is diagnosed.

• #2 Non-Alcoholic Fatty Liver Disease: Diagnosis and Evaluation of Disease Severity

  https://brieflands.com/articles/thrita-18174

  In view of the limitations of the above-mentioned modalities, liver biopsy remains the gold standard method for documentation of diagnosis and estimation of disease severity in NAFLD. […] The documentation of diagnosis is the first step in the management of these patients. NAFLD is yet a diagnosis of exclusion. Diagnosis is based on the patient history, physical examination, laboratory findings, and imaging studies. […] Liver biopsy is already considered as the gold standard method to diagnose and evaluate the extent of liver parenchymal damage in NAFLD. […] Liver biopsy is already considered the gold standard method for the diagnosis of NAFLD. It is used when definitive clinical and laboratory findings are absent for ruling out the other causes of chronic hepatitis. […] Liver biopsy is not necessary for the diagnosis of NAFLD when the clinical and paraclinical findings are apparently in favor of NAFLD diagnosis and other causes are excluded. The typical histological findings in NAFLD are shown in Table 5. Clinical findings, imaging studies and laboratory investigations have limitations for predicting the severity of disease. Liver biopsy is already considered as the method of choice for evaluation the extent of steatosis, inflammation, and fibrosis in NAFLD. However, the possible risks and invasiveness have limited its use in common practice.

• #2 Metabolic Dysfunction-Associated Steatotic Liver Disease Diagnosis – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/nafl/diagnosis.asp

  The most common chronic liver disease in U.S. affecting 2.7 million Veterans, NAFLD is a leading cause of cirrhosis and hepatocellular carcinoma and a leading indication for liver transplantation. […] Early identification by primary care providers and implementation of lifestyle modifications in patients with evidence of fibrosis progression is critical. […] Patients who are overweight or obese and have persistently elevated ALT or fatty liver on imaging should be evaluated for NAFLD. […] Diabetic patients should have a liver panel every 1-2 years. Patients with an elevated ALT (for 6 months) with no other etiology for liver injury (e.g., medications, viral hepatitis B or C, hemochromatosis, etc.) should be assessed for fibrosis risk using an online Fibrosis-4 score (FIB-4) calculator.

• #2 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  29. No recommendation can be made with regards to non-heavy consumption of alcohol by individuals with NAFLD. […] 30. Given the lack of evidence to show that patients with NAFLD and NASH are at increased risk for serious drug-induced liver injury from statins, statins can be used to treat dyslipidemia in patients with NAFLD and NASH. […] 31. Until randomized controlled trials (RCTs) with histological endpoints prove their efficacy, statins should not be used to specifically treat NASH. […] 32. When steatosis and steatohepatitis are evident in patients with other types of chronic liver disease, it is important to assess for metabolic risk factors and alternate etiologies for hepatic steatosis. […] 33. In patients with other types of chronic liver diseases who have co-existing NAFLD and NASH, there are no data to support the use of vitamin E or pioglitazone to improve the liver disease.

• #2 Diagnosis and Characterization of Non-Alcoholic Fatty Liver Disease | IntechOpen

  https://www.intechopen.com/chapters/58896

  The principal metabolic factor of the risk of NAFLD progression is DM2. […] The other factor having the greatest effect on the disease progression is liver fibrosis. […] Therefore, patients with NASH and significant fibrosis, which is indicative of important cellular damage, are also at risk of developing this liver tumor. […] With all this information, we recommend recalculating NFS and/or FIB-4 every 4-5 years for patients with NAFL without risk factors or if the patient develops DM2; in patients with NASH without significant fibrosis, we recommend an annual follow-up with a calculation of NFS and/or FIB-4 and carrying out TE and ultrasound, and in patients with significant fibrosis, a 6-monthly follow-up is recommended with special interest in screening for HCC.

• #2 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  23. Ursodeoxycholic acid (UDCA) is not recommended for the treatment of NAFLD or NASH. […] 24. It is premature to recommend omega-3 fatty acids for the specific treatment of NAFLD or NASH but they may be considered as the first line agents to treat hypertriglyceridemia in patients with NAFLD. […] 25. Foregut bariatric surgery is not contraindicated in otherwise eligible obese individuals with NAFLD or NASH (but without established cirrhosis). […] 26. The type, safety and efficacy of foregut bariatric surgery in otherwise eligible obese individuals with established cirrhosis due to NAFLD are not established. […] 27. It is premature to consider foregut bariatric surgery as an established option to specifically treat NASH. […] 28. Patients with NAFLD should not consume heavy amounts of alcohol.

• #2 Fatty liver disease A practical guide for GPs

  https://www.racgp.org.au/afp/2013/july/fatty-liver-disease

  Confirming hepatic fatty infiltration using ultrasound is important. […] The risk of fibrosis and progressive liver disease in NAFLD increases with severity of insulin resistance. […] Staging liver disease and detecting cirrhosis is the most important aspect of assessing fatty liver disease. […] Non-invasive tools for estimating the degree of fibrosis include transient elastography (FibroScan), acoustic radiation force impulse (ARFI), and non-invasive biomarker algorithms such as NAFLD Fibrosis Score, FibroTest and Hepascore. […] The cornerstone to managing NAFLD is achieving weight control and reduction in cardiovascular risk factors such as smoking, diabetes, hypertension and dyslipidaemia. […] Weight reduction via caloric restriction and regular exercise are important, and no medications can currently be recommended as specific therapy. […] General practitioners are vital in identifying patients at risk of NAFLD, and encouraging initiation and maintenance of appropriate lifestyle changes.

• #2 New Title: Metabolic Dysfunction Associated Steatotic Liver Disease (MAFLD) – Diagnosis and Management – PcMED Project

  https://pcmedproject.com/gi/nonalcoholic-fatty-liver-disease-nafld-diagnosis-and-management/

  Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) has replaced the term Non-Alcoholic Fatty Liver Disease. […] Findings of hepatic steatosis on imaging and/or elevated liver function tests require evaluation for MASLD. […] Evaluation of MASLD starts with non-invasive blood test monitoring and measuring liver stiffness. […] Diagnosis implies minimal alcohol […] Liver biopsy may be needed to confirm this diagnosis. […] Routine Labs […] FIB-4: Estimate amount of liver scarring fibrosis […] Most popular noninvasive blood test for liver fibrosis. […] Liver stiffness measurement (LSM) via transient elastography (FibroScan) […] Best screening imaging test for fibrosis. […] The Alcohol Use Disorders Identification Test (AUDIT) 10-item screening tool developed by WHO. […] If indicated, should be given […] No contraindication if LFTs are abnormal from NAFLD. […] Specialist Referrals […] Hepatologist if indeterminant or advanced fibrosis. […] Clinical Care Pathway for the Risk Stratification and Management of Patients with Nonalcoholic Fatty Liver Disease.

• #2 Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease – Altamirano – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/5631/html

  Fibrosis plays a central role in prognosticating NAFLD, whereas steatosis has an inverse association with fibrosis and thus its prognostic role is limited to early stages of the disease. […] Thus, our algorithm starts with fibrosis classification and then adds CAP or PDFF to help identify NAFLD, under the assumption that other causes of hepatic steatosis have already been ruled out. […] The presence of F2 with steatosis or F3 (advanced fibrosis) without steatosis calls for a liver biopsy, although in patients who are reluctant to undergo this procedure starting treatment is a reasonable option. […] Finally, patients with F3 and steatosis or F4 (cirrhosis) should not be delayed for treatment and appropriate screening. […] In NAFLD patients in need of a surgical procedure (liver resection or bariatric) a similar finding would preclude surgery due to the presence of clinically significant portal hypertension. […] In summary, kinetics of LSM and CAP may be useful methods for monitoring alcohol abuse and relapse in patients with ALD.

• #2 Diagnostic Modalities of Non-Alcoholic Fatty Liver Disease: From Biochemical Biomarkers to Multi-Omics Non-Invasive Approaches

  https://www.mdpi.com/2075-4418/12/2/407

  Current guidelines recommend against systematic screening for NAFLD in the general population. […] However, screening in high-risk groups, such as patients with metabolic disorders (T2DM, obesity, hypertension, dyslipidaemia), is still open for debate. […] The present review article provides a comprehensive overview of the currently available and emerging non-invasive diagnostic tools used in assessing NAFLD, also highlighting the importance of accurate and validated diagnostic tools.

• #2 Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease

  https://www.mdpi.com/1422-0067/24/3/2844

  Because liver biopsy has important risks and cannot be applied broadly, identifying novel noninvasive biomarkers for simple steatosis, NASH and fibrosis is very important. […] Currently, non-coding RNA can serve as an emerging non-invasive biomarker for NAFLD detection. […] Routine ultrasonography is broadly utilized for the diagnosis of steatosis, which presents as a typical hyperechoic liver. […] MRI is a non-invasive test that quantitates liver fat amounts with high spatial resolution and no ionizing radiation. […] Currently, the number of drug-related trials (monotherapy and combination) is the largest from the perspective of intervention, especially in terms of phase II trials (IIa, IIa/IIb, IIb).

• #2 Multiparametric MR Index for the Diagnosis of Non-Alcoholic Steatohepatitis in Patients with Non-Alcoholic Fatty Liver Disease | Scientific Reports

  https://www.nature.com/articles/s41598-020-59601-3

  Although MRS, MRE, and T1 mapping have shown good diagnostic performance in detecting and grading NASH components such as steatosis or fibrosis, it is difficult to diagnose NASH with one modality only because NASH is characterized by various components including steatosis, lobular inflammation, ballooning degeneration, and fibrosis. […] Therefore, we postulated that a non-invasive multiparametric MR index combining MRS, MRE, and T1 mapping may help diagnose NASH in NAFLD patients, thereby potentially reducing the need for liver biopsy. […] The purpose of this study was to evaluate the feasibility of MRI for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in NAFLD patients. […] Our newly devised MR index predicted NASH in NAFLD patients with a sensitivity of 80.0% and a specificity of 85.2%. […] Therefore, this multiparametric MR index may help diagnose NASH in NAFLD patients and potentially reduce the need for liver biopsy.

• #2 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  Identifying patients with cirrhosis non-invasively, as opposed to advanced fibrosis, is a major priority in the field of NAFLD, as such patients require specific clinical management including screening for hepatocellular carcinoma, oesophageal varices and sarcopaenia as recommended by most international guidelines. Moreover, specific therapeutic trials are being conducted for patients with cirrhotic NASH, making it necessary to accurately select candidates for these studies. New non-invasive tests specifically developed for the diagnosis of cirrhosis are now available. Agile4 combines VCTE results with routine parameters from liver evaluation (serum transaminases, platelets, with sex and diabetes) in a formula dedicated to cirrhosis. CirrhoMeterV3G (CMV3G) has been developed to target cirrhosis by using the same biomarkers than those included in the specialized blood test FibroMeterV3G (FMV3G). These tests dedicated to the diagnosis of cirrhosis offer the opportunity to improve the currently recommended algorithms for the non-invasive diagnosis of advanced liver fibrosis.

• #2 Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-non-invasive-diagnosis-non-alcoholic-fatty-liver-S1665268120301794

  The ultrasonography measure of right liver lobe diameter by itself can reliably identify patients with NAFLD with a good sensitivity and specificity, however, this can be improved by adding the LAP mathematical index in our population. […] The purpose of this study is to analyze whether the use of an algorithm that involves both clinical indices and hepatic ultrasound, improves the accuracy for the diagnosis of NAFLD. […] Our results show that the simple measurement with conventional ultrasound of the right hepatic lobe diameter is a good clinical marker based on its AUROC value. […] We propose that development of a new predictive score of NAFLD, involving LAP and the diameter of the right hepatic lobe, could be an easily accessible, non-invasive measurement for the early diagnosis of the disease, reducing costs and increasing the viability of the timely management of the disease. This non-invasive tool could be used in first level medical care by limiting the progression of the disease. […] In conclusion, according our results, ultrasonographic measure of right liver lobe diameter by itself is able to reliably identify patients with NAFLD with a good sensitivity and specificity. Moreover, its diagnostic efficiency can be improved by adding the LAP mathematical index in our population.

• #2 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  19. Metformin has no significant effect on liver histology and is not recommended as a specific treatment for liver disease in adults with nonalcoholic steatohepatitis (NASH). […] 20. Pioglitazone can be used to treat steatohepatitis in patients with biopsy-proven NASH. However, it should be noted that majority of the patients who participated in clinical trials that investigated pioglitazone for NASH were non-diabetic and that long term safety and efficacy of pioglitazone in patients with NASH is not established. […] 21. Vitamin E (α-tocopherol) administered at daily dose of 800 IU/day improves liver histology in non-diabetic adults with biopsy-proven NASH and therefore it should be considered as a first-line pharmacotherapy for this patient population. […] 22. Until further data supporting its effectiveness become available, vitamin E is not recommended to treat NASH in diabetic patients, NAFLD without liver biopsy, NASH cirrhosis or cryptogenic cirrhosis.

• #2

  https://link.springer.com/article/10.1007/s00125-016-3944-1

  The challenge for the diabetologist is to identify those at risk for advanced liver disease amongst those who have incidentally discovered steatosis and those with no such history. […] The EASLEASDEASO NAFLD guidelines recommend screening for NAFLD in all patients with the metabolic syndrome or type 2 diabetes using at least LFTs but also steatosis biomarkers such as the NAFLD liver fat score based on knowledge of the metabolic syndrome, type 2 diabetes, fasting serum insulin, AST, AST/ALT. […] Diagnosis of NASH still requires a liver biopsy.

• #2 MASLD, NAFLD and fatty liver disease – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/masld-nafld-and-fatty-liver-disease/

  If your doctor thinks you have any form of liver disease they will try to find out what is causing it and how damaged your liver is. Doctors use a range of tests to get different information and build up an overall picture of what is happening. […] MASLD and NAFLD might only be diagnosed when they have become serious. Or you might be diagnosed after having tests for another health problem. […] The new name MASLD stands for metabolic dysfunction-associated steatotic liver disease. […] The old name NAFLD stands for non-alcohol related fatty liver disease. […] There are currently no medicines available in the UK to specifically treat MASLD. But there is a lot of research being done to develop some. […] Treatment for fatty liver disease (MASLD or NAFLD) has 2 main aims: To stop the condition getting worse, so that it does not lead to liver cancer or liver failure. To help your liver repair as much of the damage as possible.

• #3 Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease

  https://www.mdpi.com/1422-0067/24/3/2844

  Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease that affects approximately one-quarter of the global adult population, posing a significant threat to human health with wide-ranging social and economic implications. […] Liver biopsy is currently considered the gold standard for the diagnosis and staging of NAFLD because of the absence of noninvasive and specific biomarkers. […] Therefore, the early detection, diagnosis and treatment of NAFLD has become urgent. The present review describes current findings about the pathogenesis of NAFLD and highlights progress in its diagnosis and treatment, which may help improve the outcomes of NAFLD cases. […] With Westernized eating habits and urbanization, NAFLD prevalence is higher than previously predicted, with a quickly rising trend globally. Therefore, developing reliable and practical tools for diagnosing NAFLD during disease screening is very important in the early detection and effective therapy of NAFLD.

• #3 Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging | Frontline Gastroenterology

  https://fg.bmj.com/content/5/3/211

  Non-alcoholic fatty liver disease (NAFLD) is now the commonest cause of abnormal liver function tests (LFTs) in the UK with approximately a third of the population being affected. […] Many patients with NAFLD remain undiagnosed, and recognising those at risk is the first step. […] Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, the majority of patients can be effectively diagnosed non-invasively with tests that are routinely available in the clinic today. […] A diagnosis of NAFLD requires that there is evidence of hepatic steatosis on imaging or histology, and other causes of liver disease or steatosis have been excluded. […] NAFLD is usually asymptomatic, so diagnosis usually follows the incidental finding of abnormal liver enzymes or steatosis on imaging.

• #3 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) […] Preferred approaches to the diagnostic, therapeutic and preventive aspects for the care of patients with non-alcoholic fatty liver disease. […] 1. Ongoing or recent alcohol consumption > 21 drinks on average per week in men and > 14 drinks on average per week in women is a reasonable definition for significant alcohol consumption when evaluating patients with suspected nonalcoholic fatty liver disease (NAFLD) in clinical practice. […] 2. When patients with unsuspected hepatic steatosis detected on imaging have symptoms or signs attributable to liver disease or have abnormal liver biochemistries, they should be evaluated as though they have suspected NAFLD and worked-up accordingly. […] 3. In patients with unsuspected hepatic steatosis detected on imaging who lack any liver-related symptoms or signs and have normal liver biochemistries, it is reasonable to assess for metabolic risk factors (e.g., obesity, glucose intolerance, dyslipidemia) and alternate causes for hepatic steatosis such as significant alcohol consumption or medications.

• #3 Diagnosis and management of non-alcoholic fatty liver disease (NAFLD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-non-alcoholic-fatty-liver-disease-nafld/

  29. No recommendation can be made with regards to non-heavy consumption of alcohol by individuals with NAFLD. […] 30. Given the lack of evidence to show that patients with NAFLD and NASH are at increased risk for serious drug-induced liver injury from statins, statins can be used to treat dyslipidemia in patients with NAFLD and NASH. […] 31. Until randomized controlled trials (RCTs) with histological endpoints prove their efficacy, statins should not be used to specifically treat NASH. […] 32. When steatosis and steatohepatitis are evident in patients with other types of chronic liver disease, it is important to assess for metabolic risk factors and alternate etiologies for hepatic steatosis. […] 33. In patients with other types of chronic liver diseases who have co-existing NAFLD and NASH, there are no data to support the use of vitamin E or pioglitazone to improve the liver disease.

• #3 NASH Diagnosis: Testing Methods & Procedures

  https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-diagnosis/

  How does my doctor determine if I have NAFLD or NASH? […] Because most people with NAFLD have no symptoms and screening for it is not recommended at this time, fatty liver disease is often discovered during a routine blood test or screening for another medical condition. […] Your doctor will use a variety of methods to determine if you have fatty liver disease. […] As part of the medical history, your doctor will ask: […] About your alcohol use, to determine whether the fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver disease. […] During the physical exam, your doctor will: […] Examine your body looking for signs of NAFLD or NASH such as an enlarged liver or yellowing of your skin and whites of your eyes (jaundice). […] The following blood tests will be included as part of your medical evaluation.

• #3 Non-Alcoholic Fatty Liver Disease (NAFLD): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/liver-diseases/fatty-liver-disease-non-alcoholic/treatment

  How is NAFLD Diagnosed? […] NAFLD may be identified from a routine medical test or evaluation for other conditions. The first signs may be elevated liver enzymes or fat in the liver seen on an ultrasound. Your doctor can order blood tests to look for other causes of liver disease. In addition, your doctor will assess your medical history, conduct a physical exam, and order tests. […] Blood tests may indicate that there is fat +/- inflammation in the liver. Many patients with NAFLD may have mild to moderate elevations in liver enzymes (alanine aminotransferase test ALT and aspartate aminotransferase test AST). […] If liver enzymes are elevated, your doctor may order additional tests to find the cause of the inflammation and diagnose non-alcoholic fatty liver disease. […] Your doctor may perform a liver biopsy to determine the severity of fatty liver disease. […] A piece of liver tissue is removed for examination during a liver biopsy. This is usually an outpatient procedure using a local anesthetic to lessen pain.

• #3 Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-00980-1

  Given the increasing prevalence of diabetes and obesity worldwide, the deleterious effects of non-alcoholic fatty liver disease (NAFLD) are becoming a growing challenge for public health. […] In these patients, advanced fibrosis is the major predictor of morbidity and liver-related mortality, and an accurate diagnosis of NASH and NAFLD is mandatory. Histologic evaluation with liver biopsy remains the gold standard to diagnose NAFLD. Diagnosis of NAFLD is defined as presence of hepatic steatosis, ballooning and lobular inflammation with or without fibrosis. […] In terms of diagnostic tests, the gold standard to investigate any form of liver inflammation e.g. damage is a liver biopsy. In the diagnosis of NAFLD and related disorders, liver biopsies can be extremely helpful and its findings can range from triglyceride deposition as droplets in the hepatocyte to more extensive forms of non-alcoholic steatohepatitis (NASH).

• #3 Diagnosis of NAFLD – Non-Alcoholic Fatty Liver Disease – Nash24x7

  https://www.nash24x7.com/diagnosis/

  Imaging studies that are commonly used in the diagnosis of NAFLD are […] A person will be diagnosed with NAFLD only if there is fat accumulation in liver in imaging studies (ultrasound and CT) with no significant consumption of alcohol, no other competing reasons for fatty Liver and no other co –existing liver diseases. […] To know the whether the degree of fibrosis is advanced, bridging fibrosis (stage 3) or cirrhosis (stage 4) your doctor will use the following […] NASH cannot be diagnosed by blood tests and imaging studies. At present, the only reliable way of diagnosing whether a person with fatty liver has NASH is by a liver biopsy. […] Liver Biopsy is considered only in NAFLD patients with […] NASH can be diagnosed only by a biopsy and only if the tested piece of liver shows infiltration of the liver with fat along with inflammation and different degrees of scarring. […] Your doctor may recommend you for blood tests (liver function tests), and other tests if you have risk factors for NAFLD/NASH and will proceed further depending on the test results.

• #3 Practical diagnosis of cirrhosis in non-alcoholic fatty liver disease using currently available non-invasive fibrosis tests | Nature Communications

  https://www.nature.com/articles/s41467-023-40328-4

  In this work, we used the best performing non-invasive tests currently available to liver specialists to develop and validate an accurate diagnosis of cirrhosis in patients with NAFLD, which translated in a cirrhosis category in the diagnostic algorithms currently recommended. […] Our results confirmed the very good to excellent areas under the receiver operating characteristic (AUROC) of non-invasive tests for the diagnosis of cirrhosis with results reaching 0.90 for the best tests. […] Diagnostic accuracy of the rule-out/rule-in thresholds for tests dedicated to the diagnosis of cirrhosis, alongside those tests focussed on the diagnosis of advanced fibrosis was consistent between the derivation and the validation sets. […] The study algorithm correctly diagnosed 86% of the patients and required liver biopsy in only 20% of the patients. Importantly, 88% of the misclassified patients in the validation set were by only one fibrosis stage.

• #3 Fatty Liver Disease: Blood Tests for Diagnosis

  https://www.healthline.com/health/blood-tests-for-fatty-liver

  Doctors can diagnose fatty liver disease, now called metabolic dysfunction-associated steatotic liver disease (MASLD), using blood tests that measure serum liver enzyme levels. Elevated enzyme levels may indicate inflammation and disease in the liver. […] Instead of nonalcoholic fatty liver disease (NAFLD), experts now call it metabolic dysfunction-associated steatotic liver disease (MASLD). […] Your doctor may regularly test your liver enzymes if you have certain conditions related to this type of liver damage, including obesity, metabolic syndrome, and type 2 diabetes. […] Blood tests for MASLD measure key enzymes and proteins in the blood. Elevated levels of enzymes may indicate inflammation and damage in the liver. The tests to evaluate liver function are part of a broader blood test called liver function tests.

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