Literature Reviews
doi: 10.25005/2074-0581-2021-23-1-107-112
SYSTEMATIC REVIEW WITH COMPARATIVE ANALYSIS OF RECOMMENDATIONS FOR THE DIAGNOSIS OF NONALCOHOLIC FATTY LIVER DISEASE

N.A. Toktogulova

Department of Internal Medicine № 1 of the specialties «Pediatrics» and «Dentistry», Kyrgyz-Russian Slavic University named after B.N. Yeltsin, Bishkek, Kyrgyz Republic

A review of the available literature has shown that the current epidemic of nonalcoholic fatty liver disease (NAFLD) is closely related with the widespread prevalence of metabolic risk factors worldwide, such as obesity, type 2 diabetes, and dyslipidemia. In parallel with the increasing availability of effective antiviral drugs, NAFLD is rapidly becoming the most common cause of chronic liver disease in Western countries, and a similar trend is expected in Eastern countries in the coming years. This epidemic and its aftermath have prompted experts from around the world to identify effective strategies for the diagnosis, management and treatment of NAFLD. Various scientific associations from America, Europe and the Asia-Pacific region have offered recommendations based on the most recent data on NAFLD. These recommendations are consistent with the key elements of NAFLD management, but at the same time, there are significant differences in some critical points. We have identified clinical guidelines from 8 different scientific societies with a worldwide reputation, and tried to conduct a systematic and comparative analysis of the presented protocols. Differences were noted in: definition of NAFLD, screening for NAFLD in high-risk patients, a non-invasive test proposed to diagnose NAFLD and identify NAFLD patients with severe fibrosis, follow-up protocols, and finally, treatment strategy

Keywords: Nonalcoholic fatty liver disease, liver steatosis, steatohepatitis, non-invasive tests, diagnostics, guidelines.

Download file:

References
  1. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-402. Available from: https://doi.org/10.1016/j.jhep.2015.11.004
  2. National Institute for Health and Care Excellence (UK). Non-Alcoholic Fatty Liver Disease: Assessment and Management. Available from: URL: http// www.niceorg.uk\guidance\ng49
  3. Chitturi S, Wong VW, Chan WK, Wong GL, Wong SK, Sollano J, et al. The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017 – Part 2: Management and special groups. J Gastroenterol Hepatol. 2018;33:86-98. Available from: https://doi.org/10.1111/jgh.13856
  4. Ivashkin VT, Maevskaya MV, Pavlov ChS, Tikhonov IN, Shirokova EN, Bueverov AO, i dr. Klinicheskie rekomendatsii po diagnostike i lecheniyu nealkogol’noy zhirovoy bolezni pecheni Rossiyskogo obshchestva po izucheniyu pecheni i Rossiyskoy gastroenterologicheskoy assotsiatsii [Clinical guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease of the Russian Society for the Study of the Liver and the Russian Gastroenterological Association]. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2016;26(2):24-42.
  5. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67:328-57. Available from: https://doi.org/10.1002/hep.29367
  6. The Korean Association for the Study of the Liver (KASL). Clin Mol Hepatol. 2013;19(4):325-48. Available from: https://doi.org/10.3350/ cmh.2013.19.4.325
  7. Italian Association for the Study of the Liver (AISF). AISF position paper on nonalcoholic fatty liver disease (NAFLD): Updates and future directions. Dig Liver Dis. 2017;49:471-83. Available from: https://doi.org/10.1016/j. dld.2017.01.147
  8. Watanabe S, Hashimoto E, Ikejima K, Uto H, Ono M, Sumida Y, et al. Evidence- based clinical practice guidelines for nonalcoholic fatty liver disease/ nonalcoholic steatohepatitis. Japan Society of Hepatology. J Gastroenterol. 2015;50(4):364-77. Available from: https://doi.org/10.1007/s00535-015- 1050-7
  9. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology. 2002;123:745-50. Available from: https://doi.org/10.1053/ gast.2002.35354
  10. Park CC, Nguyen P, Hernandez C, Bettencourt R, Ramirez K, Fortney L, et al. Magnetic resonance elastography vs transient elastography in detection of fibrosis and noninvasive measurement of steatosis in patients with biopsy-proven nonalcoholic fatty liver disease. Gastroenterology. 2017;152(3):598-607.e2. Available from: https://doi.org/10.1053/j.gastro. 2016.10.026
  11. Kwok R, Choi KC, Wong GL, Zhang Y, Chan HL, Luk AO, et al. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut. 2016;65:1359-68. Available from: https://doi.org/10.1136/gutjnl- 2015-309265
  12. Yoneda M, Yoneda M, Mawatari H, Fujita K, Endo H, Iida H, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis. 2008;40:371-8.
  13. Obara N, Ueno Y, Fukushima K, Nakagome Y, Kakazu E, Kimura O, et al. Transient elastography for measurement of liver stiffness measurement can detect early significant hepatic fibrosis in Japanese patients with viral and nonviral liver diseases. J Gastroenterol. 2008;43:720-8.
  14. Vuppalanchi R, Gould RJ, Wilson LA, Unalp-Arida A, Cummings OW, Chalasani N, et al. Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN). Clinical significance of serum autoantibodies in patients with NAFLD: results from the nonalcoholic steatohepatitis clinical research network. Hepatol Int. 2012;6:379-85. Available from: https://doi.org/10.1007/s12072-011-9277-8
  15. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A, et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol. 2006;6:33. Available from: https://doi.org/10.1186/1471-230X-6-33
  16. Kotronen A, Peltonen M, Hakkarainen A, Sevastianova K, Bergholm R, Johansson LM, et al. Prediction of nonalcoholic fatty liver disease and liver fat using metabolic and genetic factors. Gastroenterology. 2009;137:865-72. Available from: https://doi.org/10.1053/j.gastro.2009.06.005
  17. Feldstein AE, Wieckowska A, Lopez AR, Liu YC, Zein NN, McCullough AJ. Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: A multicenter validation study. Hepatology. 2009;50:1072-8. Available from: https://doi.org/10.1002/hep.23050
  18. Kaswala DH, Lai M, Afdhal NH. Fibrosis assessment in nonalcoholic fatty liver disease (NAFLD) in 2016. Dig Dis Sci. 2016;61:1356-64. Available from: https://doi.org/10.1007/ s10620-016-4079-4
  19. Kleiner DE, Brunt EM. Nonalcoholic fatty liver disease: pathologic patterns and biopsy evaluation in clinical research. Semin Liver Dis. 2012;32:3-13. Available from: https://doi.org/10.1055/s-0032-1306421
  20. Bedossa P, Poitou C, Veyrie N, Bouillot JL, Basdevant A, Paradis V, et al. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology. 2012;56:1751-9. Available from: https://doi.org/10.1002/ hep.25889
  21. Bedossa P, FLIP Pathology Consortium. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology. 2014;60:565-75. Available from: https://doi. org/10.1002/hep.27173

Authors' information:

Toktogulova Nurgul Asylbekovna
Candidate of Medical Sciences, Associate Professor, Head of the Department of Internal Medicine № 1 of the specialties «Pediatrics» and «Dentistry», Kyrgyz-Russian Slavic University named after B.N. Yeltsin
Researcher ID: AAA-7576-2021
Scopus ID: 56891587900
ORCID ID: 0000-0002-8976-1636
SPIN: 6998-7300
Author ID: 1027987
E-mail: t.nur30@mail.ru

Information about support in the form of grants, equipment, medications

The work was carried out according to the plan of scientific research works of Kyrgyz-Russian Slavic University named after B.N. Yeltsin (registration number – 88988-3300-M-e). The author did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Toktogulova Nurgul Asylbekovna
Candidate of Medical Sciences, Associate Professor, Head of the Department of Internal Medicine № 1 of the specialties «Pediatrics» and «Dentistry», Kyrgyz-Russian Slavic University named after B.N. Yeltsin

720000, Kyrgyz Republic, Bishkek, Kievskaya Str., 44

Tel.: +996 (555) 279716

E-mail: t.nur30@mail.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

◄ Back to the list