Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2018; 24(30): 3361-3373
Published online Aug 14, 2018. doi: 10.3748/wjg.v24.i30.3361
Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis
Simona Leoni, Francesco Tovoli, Lucia Napoli, Ilaria Serio, Silvia Ferri, Luigi Bolondi
Simona Leoni, Francesco Tovoli, Lucia Napoli, Ilaria Serio, Silvia Ferri, Luigi Bolondi, Department of Medical and Surgical Sciences (DIMEC), Division of Internal Medicine, University of Bologna, Bologna 40136, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision, editing and approval of final version.
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Simona Leoni, MD, PhD, Doctor, Department of Medical and Surgical Sciences (DIMEC), Division of Internal Medicine, University of Bologna, via Massarenti 9, Bologna 40138, Italy.
Telephone: +39-51-2142214 Fax:+39-51-2142725
Received: May 9, 2018
Peer-review started: May 10, 2018
First decision: May 24, 2018
Revised: May 31, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: August 14, 2018

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.