Published in Clinical Gastroenterology and Hepatology (May 2023)
The spectrum of non-alcoholic fatty liver disease (NAFLD) is divisible into three stages: 1) NAFL, 2) non-alcoholic steatohepatitis (NASH), NAFLD’s progressive and inflammatory subtype, and 3) NAFLD or NASH with fibrosis, whose stages range from F0-4.
Authors: Guixé-Muntet S, Biquard L, Szabo G et al.
Published in Alimentary Pharmacology and Therapeutics (July 2022)
Hepatic microvascular dysfunction is central to the development and progression of nonalcoholic steatohepatitis (NASH), the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD).
Along with its association with metabolic syndrome, NAFLD is closely linked with mixed dyslipidaemia (reduced high-density lipoprotein cholesterol (HDL-C) and increased very low-density lipoprotein triglycerides (VLDL-TG)).
Published in Clinical and Molecular Hepatology (April 2023)
Up to 30% of patients with non-alcoholic fatty liver disease (NAFLD) progress to non-alcoholic steatohepatitis (NASH), significantly increasing their risk of fibrosis and associated adverse outcomes. As such, ensuring the early identification of NAFLD and NASH in at-risk patients is a clinical priority.
Changing the terminology from NAFLD, non-alcoholic fatty liver disease, to MAFLD, metabolic dysfunction-associated fatty liver disease, has been an ongoing debate. MAFLD is based upon an individual having hepatic steatosis, as well as either type 2 diabetes mellitus, obesity (or being overweight) or if at a normal weight, two or more metabolic risk abnormalities.
Published in Clinical Gastroenterology and Hepatology (April 2023)
Patients with non-alcoholic fatty liver disease (NAFLD) are at risk of progressing to inflammatory non-alcoholic steatohepatitis (NASH), a NAFLD subtype associated with fibrosis, cirrhosis, and hepatocellular carcinoma.
Seeking the perfect NASH biomarker may be unrealistic; versatility is key. A diverse biomarker pool adapts to varied clinical contexts and settings. FIB-4, a cost-effective marker, can be supplemented by complex multimarkers for NASH therapeutic trials. Embracing diagnostic imperfections is crucial for flexible biomarker algorithms.
The rising healthcare costs of NASH highlight the need for early intervention. Higher FIB-4 scores correlate with increased healthcare expenses. Early-stage intervention can reduce the burden on patients and the healthcare system.
Heterogeneity in cut-off points for non-invasive fibrosis tests impacts NAFLD risk stratification. Standardized guidelines could improve consistency and accuracy in identifying patients requiring specialist care.
Physicians often underestimate or overestimate fibrosis severity in NASH, leading to concerns about appropriate treatment. Standardized interpretations of risk stratification tools are needed.
Patients with T2D complications have a 4.5x greater risk of developing fibrosis, independent of HbA1c levels. FIB-4 index can help identify diabetic patients at highest risk, improving primary care screening.
Authors: Boursier J, Hagström H, Ekstedt M, et al.
Published in J Hepatol 2022
FIB4 and VCTE show promise in predicting prognosis for NAFLD patients. These non-invasive tests offer an alternative to liver biopsies for risk stratification. Quick and easily prescribed, they can streamline referrals and specialized management. A sequential algorithm with FIB4 and VCTE may improve NAFLD care.
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