Copyright
©The Author(s) 2017.
World J Hepatol. Jun 8, 2017; 9(16): 715-732
Published online Jun 8, 2017. doi: 10.4254/wjh.v9.i16.715
Published online Jun 8, 2017. doi: 10.4254/wjh.v9.i16.715
Table 1 Non-alcoholic fatty liver disease activity scoring system[121]
Steatosis, grade (0-3) | |
< 5% | 0 |
5%-33% | 1 |
34%-66% | 2 |
> 66% | 3 |
Lobular inflammation | |
No foci | 0 |
< 2 foci per 200 × field | 1 |
2-4 foci per 200 × field | 2 |
> 4 foci per 200 × field | 3 |
Hepatocyte ballooning | |
None | 0 |
Few balloon cells | 1 |
Many cells/prominent ballooning | 2 |
Fibrosis stage | |
None | 0 |
Perisinusoidal or periportal | 1 |
Mild, zone 3, perisinusoidal | 1A |
Moderate, zone 3, perisinusoidal | 1B |
Portal/periportal | 1C |
Perisinusoidal and portal/periportal | 2 |
Bridging fibrosis | 3 |
Cirrhosis | 4 |
Steatosis score (S): Assessed the quantities of large or medium-sized lipid droplets (0-3) |
S0: < 5% |
S1: 5%-33% |
S2: 34%-66% |
S3: > 67% |
Activity grade (0-4): Sum of scores for ballooning and lobular inflammation |
A1: Mild activity |
A2: Moderate activity |
A3 and A4: Severe activity |
Hepatocyte ballooning (0-2) |
0: None |
1: Foci of hepatocytes with rounded shape, pale or reticulated cytoplasm |
2: Foci of hepatocytes with rounded shape, pale or reticulated cytoplasm and enlargement (> 2 × normal size) |
Lobular inflammation (0-2) |
0: None |
1: < 2 foci per 20 × field |
2: > 2 foci per 20 × field |
Fibrosis stage (F) |
F0: No relevant fibrosis |
F1: 1a - mild zone 3 perisinusoidal fibrosis |
1b - moderate zone 3 perisinusoidal fibrosis |
1c - portal fibrosis |
F2: Zone 3 perisinusoidal fibrosis with periportal fibrosis |
F3: Bridging fibrosis |
F4: Cirrhosis |
Table 3 Brunt grading and staging of nonalcoholic steatohepatitis[96]
Grading | Staging |
Mild (Grade 1) | Stage 1 |
Steatosis (mostly macrovesicular) | Zone 3 perisinusoidal/pericellular fibrosis (focal or extensive) |
Involves up to 66% of biopsy | |
Occasional ballooned zone 3 hepatocytes | Stage 2 |
Scattered rare intra-acinar neutrophils with/without associated lymphocytes | Zone 3 perisinusoidal/pericellular fibrosis with associated focal or extensive periportal fibrosis |
No/mild portal chronic inflammation | |
Moderate (Grade 2) | |
Steatosis-any degree | |
Ballooning hepatocytes-zone 3 | |
Intra-acinar neutrophils-may be associated with zone 3 pericellular fibrosis | Stage 3 |
Portal and intra-acinar chronic inflammation | Zone 3 perisinusoidal/pericellular fibrosis and portal fibrosis with associated focal or extensive bridging fibrosis |
Severe (Grade 3) | |
Panacinar steatosis | |
Ballooning-zone 3 | |
Intra-acinar inflammation with scattered neutrophils | Stage 4 |
Neutrophils associated with ballooned hepatocytes with/without chronic inflammation | Cirrhosis |
Chronic portal inflammation-mild or moderate |
Table 4 Histologic comparison of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and alcoholic liver disease[129]
Characteristic | NAFLD and NASH | Alcoholic liver disease |
Disease severity | Mild | Varying |
Mallory-Denk body | Poorly formed | Well formed |
Glycogenated nuclei | Common | Less common |
Ductular proliferation | Less prominent | More prominent |
Fibrosis/cirrhosis | Less common | More common |
Sclerosing hyaline necrosis | None/rare | Present |
Phlebosclerosis | None/rare | Present |
Canalicular cholestasis | None/rare | Present |
Foamy degeneration | None/rare | Present |
Table 5 Factors to be assessed in the evaluation of a patient with suspected non-alcoholic fatty liver disease[32]
Factor |
Personal and family history of diabetes, hypertension and CVD |
Alcohol use: < 20 g/d (women), < 30 g/d (man) |
Waist circumference, BMI, change in body weight |
Hepatitis B/C infection |
Liver enzymes |
History of steatosis-associated drug use |
Fast blood glucose, hemoglobin A1c |
Serum total and HDL-cholesterol, triacylglycerol, uric acid |
Undertaken due to clinical suspicion |
Ultrasound |
Hemochromatosis testing: Ferritin and transferrin saturation |
Celiac disease: IgA and tissue transglutaminase |
Thyroid disease: TSH level (T3/T4) |
Polycystic ovarian syndrome |
Wilson’s disease: Ceruloplasmin |
Autoimmune disease: ANA, AMA, SMA |
Alpha-1 antitrypsin deficiency: Alpha-1-antitrypsin level |
- Citation: Benedict M, Zhang X. Non-alcoholic fatty liver disease: An expanded review. World J Hepatol 2017; 9(16): 715-732
- URL: https://www.wjgnet.com/1948-5182/full/v9/i16/715.htm
- DOI: https://dx.doi.org/10.4254/wjh.v9.i16.715