Should We Screen High-Risk Populations for NAFLD?
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FATTY LIVER DISEASE (V AJMERA, SECTION EDITOR)
Should We Screen High-Risk Populations for NAFLD? Cyrielle Caussy 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose of review Nonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide and yet remains largely underdiagnosed. However, whether a systematic screening in high-risk population for NAFLD should be performed remains debated. Recent findings Over the past decade, a better knowledge of the natural history and epidemiology of NAFLD has identified highrisk population for NAFLD including obese and type 2 diabetes patients. Moreover, the presence of advanced fibrosis has been identified as the major determinant of overall and liver-related mortality. Moreover, several non-invasive biomarkers have been developed for the screening of advanced fibrosis while therapeutic clinical trials are intensive field of research. Summary Screening for advanced fibrosis in high-risk population for NAFLD should be performed as it would benefit to the patients. However further studies are needed to determine the optimal strategy and cost-effectiveness of such screening. Keywords Obesity . Nonalcoholic fatty liver disease . Type 2 diabetes . Fibrosis . Cirrhosis . Biomarkers
Introduction Nonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide affecting 25–30% of the adult population [1•]. NAFLD is defined by evidence of hepatic steatosis, either by imaging or histology, and lack of secondary causes of hepatic fat accumulation such as significant alcohol consumption, long-term use of a steatogenic medication, or monogenic hereditary disorders [2••]. NAFLD encompasses a spectrum of disease from simple hepatic steatosis to steatohepatitis (NASH) which is considered as the progressive form with an increased risk of progression towards liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) [2••]. Despite its growing epidemic closely associated with the increase epidemic of obesity and type This article is part of the Topical Collection on Fatty Liver Disease * Cyrielle Caussy [email protected] 1
Univ Lyon, CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France
2
Hospices Civils de Lyon, Département Endocrinologie, Diabète et Nutrition, Hôpital Lyon Sud, 69495 Pierre-Bénite, France
2 diabetes mellitus (T2DM), NAFLD remains largely underdiagnosed as it remains asymptomatic until advanced stage of the disease and even patients with advanced fibrosis may have normal liver enzymes [3]. Another limitation for the diagnosis of NAFLD is the need to perform a liver biopsy which is considered as the reference standard but is expensive, invasive, and not applicable at the level of the population as a screening method. Over the past decade, better knowledge of the natural history and epidemiology of NAFLD has identified highrisk population for NAFLD and especially population with high-risk of p
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