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Abstract Details
Epidemiology and natural history of non-alcoholic fatty liver disease
Metabolism. 2016 Aug;65(8):1017-25. doi: 10.1016/j.metabol.2016.01.012.Epub 2016 Jan 29.
Yousef Fazel1, Aaron B Koenig1, Mehmet Sayiner1, Zachary D Goodman2, Zobair M Younossi3
Author information
1Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
2Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Center for Liver Diseases Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
3Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Center for Liver Diseases Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Electronic address: zobair.younossi@inova.org.
Abstract
Non-alcoholic steatohepatitis (NASH) is part of the spectrum of non-alcoholic fatty liver disease (NAFLD) that leads to progressive liver disease and presents a growing challenge to public health. Because of the increased prevalence of metabolic syndrome and obesity, NAFLD and NASH have expanded to a substantial extent. In NASH patients, advanced fibrosis is the major predictor of morbidity and liver-related mortality, and an accurate diagnosis of NASH is mandatory. Although there is currently no validated test of serum biomarkers available to diagnose NASH, and histologic evaluation with a liver biopsy remains the gold standard, screening for fibrosis is recommended in patients with suspicion of NASH. Clinical prediction models and serum biomarkers for advanced fibrosis have relatively good negative predictive value and can be useful for screening. Also, transient elastography is increasingly available to estimate fibrosis in NASH. Therefore, due to the lack of a reliable and accepted non-invasive diagnostic modality, screening for NASH in the general population is not currently recommended. Better understanding of the natural history of NASH is needed to evaluate the utility and cost-effectiveness of screening.