OtherClinical Practice Guidelines
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Position statement on the diagnosis and management of non-alcoholic fatty liver disease

Khalid A. Alswat, Hind I. Fallatah, Bandar Al-Judaibi, Hussien A, Elsiesy, Waleed K. Al-Hamoudi, Adel N. Qutub, Naif Alturaify and Abdullah Al-Osaimi
Saudi Medical Journal June 2019, 40 (6) 531-540; DOI: https://doi.org/10.15537/smj.2019.6.23980

References

  1. ↵
    1. Cholankeril G,
    2. Wong RJ,
    3. Hu M,
    4. Perumpail RB,
    5. Yoo ER,
    6. Puri P,
    7. et al.
    (2017) Liver Transplantation for non-alcoholic Steatohepatitis in the US:temporal trends and outcomes. Dig Dis Sci 62:2915–2922.
    OpenUrl
  2. ↵
    1. Sinn DH,
    2. Kang D,
    3. Chang Y,
    4. Ryu S,
    5. Gu S,
    6. Kim H,
    7. et al.
    (2017) Non-alcoholic fatty liver disease and progression of coronary artery calcium score:a retrospective cohort study. Gut 66:323–329.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    (2016) European Association for the Study of the L, European Association for the Study of D, European Association for the Study of O. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 64:1388–13402.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Chalasani N,
    2. Younossi Z,
    3. Lavine JE,
    4. Charlton M,
    5. Cusi K,
    6. Rinella M,
    7. et al.
    (2018) The diagnosis and management of non-alcoholic fatty liver disease:Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 67:328–357.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Guyatt GH,
    2. Oxman AD,
    3. Vist GE,
    4. Kunz R,
    5. Falck-Ytter Y,
    6. Alonso-Coello P,
    7. et al.
    (2008) GRADE:an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed) 336:924–926.
    OpenUrlFREE Full Text
  6. ↵
    1. Kabbany MN,
    2. Conjeevaram Selvakumar PK,
    3. Watt K,
    4. Lopez R,
    5. Akras Z,
    6. Zein N,
    7. et al.
    (2017) Prevalence of non-alcoholic Steatohepatitis-Associated Cirrhosis in the United States: An Analysis of National Health and Nutrition Examination Survey Data. Am J Gastroenterol 112:581–587.
    OpenUrl
  7. ↵
    1. Younossi ZM,
    2. Koenig AB,
    3. Abdelatif D,
    4. Fazel Y,
    5. Henry L,
    6. Wymer M
    (2016) Global epidemiology of non-alcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 64:73–84.
    OpenUrlCrossRefPubMed
  8. ↵
    1. Alswat K,
    2. Aljumah AA,
    3. Sanai FM,
    4. Abaalkhail F,
    5. Alghamdi M,
    6. Al Hamoudi WK,
    7. et al.
    (2018) Non-alcoholic fatty liver disease burden - Saudi Arabia and United Arab Emirates, 2017-2030. Saudi J Gastroenterol 24:211–219.
    OpenUrl
  9. ↵
    1. Al-Rubeaan K,
    2. Al-Manaa H,
    3. Khoja T,
    4. Ahmad N,
    5. Al-Sharqawi A,
    6. Siddiqui K,
    7. et al.
    (2014) The Saudi Abnormal Glucose Metabolism and Diabetes Impact Study (SAUDI-DM). Ann Saudi Med 34:465–475.
    OpenUrl
  10. ↵
    1. Alsabaani AA,
    2. Mahfouz AA,
    3. Awadalla NJ,
    4. Musa MJ,
    5. Al Humayed SM
    (2018) Non-Alcoholic Fatty Liver Disease among Type-2 diabetes mellitus patients in Abha City, South Western Saudi Arabia. Int J Environ Res Public Health 15:pii:E2521.
  11. ↵
    1. Alqahtani A,
    2. Elahmedi M,
    3. Alswat K,
    4. Arafah M,
    5. Fagih M,
    6. Lee J
    (2017) Features of non-alcoholic steatohepatitis in severely obese children and adolescents undergoing sleeve gastrectomy. Surg Obes Relat Dis 13:1599–1609.
    OpenUrl
  12. ↵
    1. Al-Nozha MM,
    2. Al-Mazrou YY,
    3. Al-Maatouq MA,
    4. Arafah MR,
    5. Khalil MZ,
    6. Khan NB,
    7. et al.
    (2005) Obesity in Saudi Arabia. Saudi Med J 26:824–829.
    OpenUrlPubMedWeb of Science
  13. ↵
    1. Al-Nozha MM,
    2. Arafah MR,
    3. Al-Maatouq MA,
    4. Khalil MZ,
    5. Khan NB,
    6. Al-Marzouki K,
    7. et al.
    (2008) Hyperlipidemia in Saudi Arabia. Saudi Med J 29:282–287.
    OpenUrlPubMed
  14. ↵
    1. Al-Hamoudi W,
    2. Elsiesy H,
    3. Bendahmash A,
    4. Al-Masri N,
    5. Ali S,
    6. Allam N,
    7. et al.
    (2015) Liver transplantation for hepatitis B virus:Decreasing indication and changing trends. World J Gastroenterol 21:8140–8147.
    OpenUrl
  15. ↵
    1. Buzzetti E,
    2. Pinzani M,
    3. Tsochatzis EA
    (2016) The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism 65:1038–1048.
    OpenUrlCrossRefPubMed
  16. ↵
    1. Sookoian S,
    2. Pirola CJ
    (2011) Meta-analysis of the influence of I148M variant of patatin-like phospholipase domain containing 3 gene (PNPLA3) on the susceptibility and histological severity of non-alcoholic fatty liver disease. Hepatology 53:1883–1894.
    OpenUrlCrossRefPubMedWeb of Science
  17. ↵
    1. Eslam M,
    2. Valenti L,
    3. Romeo S
    (2018) Genetics and epigenetics of NAFLD and NASH:Clinical impact. J Hepatol 68:268–279.
    OpenUrlCrossRefPubMed
  18. ↵
    1. Argo CK,
    2. Northup PG,
    3. Al-Osaimi AM,
    4. Caldwell SH
    (2009) Systematic review of risk factors for fibrosis progression in non-alcoholic steatohepatitis. J Hepatol 51:371–379.
    OpenUrlCrossRefPubMedWeb of Science
  19. ↵
    1. Kim D,
    2. Touros A,
    3. Kim WR
    (2018) Non-alcoholic Fatty Liver Disease and Metabolic Syndrome. Clin Liver Dis 22:133–140.
    OpenUrl
  20. ↵
    1. White DL,
    2. Kanwal F,
    3. El-Serag HB
    (2012) Association between non-alcoholic fatty liver disease and risk for hepatocellular cancer, based on systematic review. Clin Gastroenterol Hepatol 10:1342.e2–1359.e2.
    OpenUrl
  21. ↵
    1. Musso G,
    2. Gambino R,
    3. Cassader M,
    4. Pagano G
    (2011) Meta-analysis:natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 43:617–649.
    OpenUrlCrossRefPubMed
  22. ↵
    1. McPherson S,
    2. Stewart SF,
    3. Henderson E,
    4. Burt AD,
    5. Day CP
    (2010) Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut 59:1265–1269.
    OpenUrlAbstract/FREE Full Text
  23. ↵
    1. Xiao G,
    2. Zhu S,
    3. Xiao X,
    4. Yan L,
    5. Yang J,
    6. Wu G
    (2017) Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with non-alcoholic fatty liver disease:A meta-analysis. Hepatology 66:1486–1501.
    OpenUrlCrossRefPubMed
  24. ↵
    1. Kwok R,
    2. Tse YK,
    3. Wong GL,
    4. Ha Y,
    5. Lee AU,
    6. Ngu MC,
    7. et al.
    (2014) Systematic review with meta-analysis:non-invasive assessment of non-alcoholic fatty liver disease--the role of transient elastography and plasma cytokeratin-18 fragments. Aliment Pharmacol Ther 39:254–269.
    OpenUrlCrossRefPubMed
    1. Tapper EB,
    2. Challies T,
    3. Nasser I,
    4. Afdhal NH,
    5. Lai M
    (2016) The performance of vibration controlled transient elastography in a US cohort of patients with non-alcoholic fatty liver disease. Am J Gastroenterol 111:677–684.
    OpenUrl
  26. ↵
    1. Cassinotto C,
    2. Boursier J,
    3. de Ledinghen V,
    4. Lebigot J,
    5. Lapuyade B,
    6. Cales P,
    7. et al.
    (2016) Liver stiffness in non-alcoholic fatty liver disease:A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy. Hepatology 63:1817–1827.
    OpenUrlCrossRefPubMed
  27. ↵
    1. Wang Y,
    2. Fan Q,
    3. Wang T,
    4. Wen J,
    5. Wang H,
    6. Zhang T
    (2015) Controlled attenuation parameter for assessment of hepatic steatosis grades:a diagnostic meta-analysis. Int J Clin Exp Med 8:17654–17663.
    OpenUrl
  28. ↵
    1. van Katwyk S,
    2. Coyle D,
    3. Cooper C,
    4. Pussegoda K,
    5. Cameron C,
    6. Skidmore B,
    7. et al.
    (2017) Transient elastography for the diagnosis of liver fibrosis:a systematic review of economic evaluations. Liver Int 37:851–861.
    OpenUrl
  29. ↵
    1. Wong VW,
    2. Chan WK,
    3. Chitturi S,
    4. Chawla Y,
    5. Dan YY,
    6. Duseja A,
    7. et al.
    (2018) Asia-Pacific Working Party on non-alcoholic Fatty Liver Disease guidelines 2017-Part 1:Definition, risk factors and assessment. J Gastroenterol Hepatol 33:70–85.
    OpenUrlCrossRefPubMed
  30. ↵
    1. Wong VW,
    2. Chalasani N
    (2016) Not routine screening, but vigilance for chronic liver disease in patients with type 2 diabetes. J Hepatol 64:1211–1213.
    OpenUrl
  31. ↵
    1. Katsagoni CN,
    2. Georgoulis M,
    3. Papatheodoridis GV,
    4. Panagiotakos DB,
    5. Kontogianni MD
    (2017) Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease:A meta-analysis. Metabolism 68:119–132.
    OpenUrlPubMed
  32. ↵
    1. Vilar-Gomez E,
    2. Martinez-Perez Y,
    3. Calzadilla-Bertot L,
    4. Torres-Gonzalez A,
    5. Gra-Oramas B,
    6. Gonzalez-Fabian L,
    7. et al.
    (2015) Weight loss through lifestyle modification significantly reduces features of non-alcoholic Steatohepatitis. Gastroenterology 149:367–378.e5, quiz e14-ne15.
    OpenUrlCrossRefPubMed
  33. ↵
    1. Keating SE,
    2. Hackett DA,
    3. George J,
    4. Johnson NA
    (2012) Exercise and non-alcoholic fatty liver disease:a systematic review and meta-analysis. J Hepatol 57:157–166.
    OpenUrlCrossRefPubMedWeb of Science
  34. ↵
    1. Haufe S,
    2. Engeli S,
    3. Kast P,
    4. Bohnke J,
    5. Utz W,
    6. Haas V,
    7. et al.
    (2011) Randomized comparison of reduced fat and reduced carbohydrate hypocaloric diets on intrahepatic fat in overweight and obese human subjects. Hepatology 53:1504–1514.
    OpenUrlCrossRefPubMed
  35. ↵
    1. Sanyal AJ,
    2. Chalasani N,
    3. Kowdley KV,
    4. McCullough A,
    5. Diehl AM,
    6. Bass NM,
    7. et al.
    (2010) Pioglitazone, vitamin E, or placebo for Non-alcoholic steatohepatitis. N Engl J Med 362:1675–1685.
    OpenUrlCrossRefPubMedWeb of Science
  36. ↵
    1. Said A,
    2. Akhter A
    (2017) Meta-Analysis of randomized controlled trials of pharmacologic agents in non-alcoholic steatohepatitis. Ann Hepatol 16:538–547.
    OpenUrl
  37. ↵
    1. Neuschwander-Tetri BA,
    2. Loomba R,
    3. Sanyal AJ,
    4. Lavine JE,
    5. Van Natta ML,
    6. Abdelmalek MF,
    7. et al.
    (2015) Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT):a multicentre, randomised, placebo-controlled trial. Lancet 385:956–965.
    OpenUrlCrossRefPubMed
  38. ↵
    1. Ratziu V,
    2. Harrison SA,
    3. Francque S,
    4. Bedossa P,
    5. Lehert P,
    6. Serfaty L,
    7. et al.
    (2016) Elafibranor, an Agonist of the Peroxisome Proliferator-Activated Receptor-alpha and -delta, Induces Resolution of Non-alcoholic Steatohepatitis Without Fibrosis Worsening. Gastroenterology 150:1147–1159.e5.
    OpenUrlCrossRefPubMed
  39. ↵
    1. Friedman SL,
    2. Ratziu V,
    3. Harrison SA,
    4. Abdelmalek MF,
    5. Aithal GP,
    6. Caballeria J,
    7. et al.
    (2018) A randomized, placebo-controlled trial of cenicriviroc for treatment of non-alcoholic steatohepatitis with fibrosis. Hepatology 67:1754–1767.
    OpenUrlCrossRefPubMed
  40. ↵
    1. Loomba R,
    2. Lawitz E,
    3. Mantry PS,
    4. Jayakumar S,
    5. Caldwell SH,
    6. Arnold H,
    7. et al.
    (2017) The ASK1 inhibitor selonsertib in patients with non-alcoholic steatohepatitis:A randomized, phase 2 trial. Hepatology 11:doi:10.1002/hep.29514.
  41. ↵
    1. Armstrong MJ,
    2. Gaunt P,
    3. Aithal GP,
    4. Barton D,
    5. Hull D,
    6. Parker R,
    7. et al.
    (2016) Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN):a multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet 387:679–690.
    OpenUrlCrossRefPubMed
  42. ↵
    1. Adams TD,
    2. Gress RE,
    3. Smith SC,
    4. Halverson RC,
    5. Simper SC,
    6. Rosamond WD,
    7. et al.
    (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357:753–761.
    OpenUrlCrossRefPubMedWeb of Science
  43. ↵
    1. Gribsholt SB,
    2. Thomsen RW,
    3. Svensson E,
    4. Richelsen B
    (2017) Overall and cause-specific mortality after Roux-en-Y gastric bypass surgery:A nationwide cohort study. Surg Obes Relat Dis 13:581–587.
    OpenUrlPubMed
  44. ↵
    1. Klebanoff MJ,
    2. Corey KE,
    3. Chhatwal J,
    4. Kaplan LM,
    5. Chung RT,
    6. Hur C
    (2017) Bariatric surgery for non-alcoholic steatohepatitis:A clinical and cost-effectiveness analysis. Hepatology 65:1156–1164.
    OpenUrlCrossRefPubMed
  45. ↵
    1. Kleiner DE,
    2. Berk PD,
    3. Hsu JY,
    4. Courcoulas AP,
    5. Flum D,
    6. Khandelwal S,
    7. et al.
    (2014) Hepatic pathology among patients without known liver disease undergoing bariatric surgery:observations and a perspective from the longitudinal assessment of bariatric surgery (LABS) study. Semin Liver Dis 34:98–107.
    OpenUrl
  46. ↵
    1. Wang X,
    2. Li J,
    3. Riaz DR,
    4. Shi G,
    5. Liu C,
    6. Dai Y
    (2014) Outcomes of liver transplantation for non-alcoholic steatohepatitis:a systematic review and meta-analysis. Clin Gastroenterol Hepatol 12:394–402.
    OpenUrlCrossRefPubMed
  47. ↵
    The Food and Drug Administration. FDA Drug Safety Communication:Important safety label changes to cholesterol-lowering statin drugs. Available from:https://www.fda.gov/drugs/drugsafety/ucm293101.htm. cited 2012.
  48. ↵
    1. Bays H,
    2. Cohen DE,
    3. Chalasani N,
    4. Harrison SA
    (2014) The National Lipid Association's Statin Safety Task F. An assessment by the Statin Liver Safety Task Force: 2014 update. J Clin Lipidol 8(3 Suppl):S47–57.
    OpenUrlCrossRefPubMed
  49. ↵
    1. Kamal S,
    2. Khan MA,
    3. Seth A,
    4. Cholankeril G,
    5. Gupta D,
    6. Singh U,
    7. et al.
    (2017) Beneficial effects of statins on the rates of hepatic fibrosis, hepatic decompensation, and mortality in chronic liver disease:A Systematic review and meta-analysis. Am J Gastroenterol 112:1495–1505.
    OpenUrl
  50. ↵
    1. Chitturi S,
    2. Wong VW,
    3. Chan WK,
    4. Wong GL,
    5. Wong SK,
    6. Sollano J,
    7. et al.
    (2018) The Asia-Pacific working party on non-alcoholic fatty liver disease guidelines 2017-Part 2:Management and special groups. J Gastroenterol Hepatol 33:86–98.
    OpenUrlCrossRefPubMed
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