Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis

Abstract

The current epidemic of non-alcoholic fatty liver disease (NAFLD) is reshaping the field of hepatology all around the world. The widespread diffusion of metabolic risk factors such as obesity, type2-diabetes mellitus, and dyslipidemia has led to a worldwide diffusion of NAFLD. In parallel to the increased availability of effective anti-viral agents, 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 next years. This epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis, management, and treatment of NAFLD. Different scientific societies from Europe, America, and Asia-Pacific regions have proposed guidelines based on the most recent evidence about NAFLD. These guidelines are consistent with the key elements in the management of NAFLD, but still, show significant difference about some critical points. We reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main differences. We distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical regions. Differences were noted in: the definition of NAFLD, the opportunity of NAFLD screening in high-risk patients, the non-invasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis, in the follow-up protocols and, finally, in the treatment strategy (especially in the proposed pharmacological management). These difference have been discussed in the light of the possible evolution of the scenario of NAFLD in the next years.

Keywords: Non-alcoholic fatty liver disease; Metformin; Liver steatosis; Liver biopsy; Non-invasive diagnosis; Pioglitazone; Clinical guidelines

Core tip: Non-alcoholic fatty liver disease (NAFLD) is becoming the most common cause of chronic liver disease. As such, an increasing number of scientific reports are investing this condition. To translate these evidence into clinical practice, international scientific societies have proposed guidelines for the management of NAFLD. In this review, we will critically analyse both the converging and diverging points in the current clinical guidelines of NAFLD, with a particular focus on the diagnostic and therapeutic aspects.