Non-alcoholic fatty liver disease classification: Difference between revisions

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{{Non alcoholic fatty liver disease}}
{{Non alcoholic fatty liver disease}}
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==Overview==
==Overview==
Non-alcoholic fatty liver (NAFLD)  disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis.


==Classification==
==Clinical Classification==
Non-alcoholic fatty liver disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis.<ref name="pmid24661406">{{cite journal| author=Hashimoto E, Tokushige K, Ludwig J| title=Diagnosis and classification of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: Current concepts and remaining challenges. | journal=Hepatol Res | year= 2015 | volume= 45 | issue= 1 | pages= 20-8 | pmid=24661406 | doi=10.1111/hepr.12333 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24661406  }} </ref><ref name="pmid28303724">{{cite journal| author=Cobbina E, Akhlaghi F| title=Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters. | journal=Drug Metab Rev | year= 2017 | volume= 49 | issue= 2 | pages= 197-211 | pmid=28303724 | doi=10.1080/03602532.2017.1293683 | pmc=5576152 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28303724  }} </ref><ref name="pmid25763333">{{cite journal| author=Monteiro JM, Monteiro GM, Caroli-Bottino A, Pannain VL| title=Nonalcoholic fatty liver disease: different classifications concordance and relationship between degrees of morphological features and spectrum of the disease. | journal=Anal Cell Pathol (Amst) | year= 2014 | volume= 2014 | issue=  | pages= 526979 | pmid=25763333 | doi=10.1155/2014/526979 | pmc=4333905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25763333  }} </ref>
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
! colspan="2" style="background:#efefef;" |Based on clinical presentation
|-
! style="background:#efefef;" |Non-alcoholic fatty liver
! style="background:#efefef;" |Non-alcoholic steatohepatitis
|-
|
* Benign
|
* Aggressive
|-
|
* Non-progressive
|
* Can progress to [[cirrhosis]]
* Rarely can give rise to [[hepatocellular carcinoma]]
|-
! colspan="2" style="background:#efefef;" |Based on Etiology
|-
|
* Primary NAFLD
|
* If the cause of the liver disease was unknown.
|-
|
* Secondary NAFLD
|
* If the cause of the liver disease is secondary to:
** Surgery for [[morbid obesity]]
** An adverse drug effect
** Conditions such as [[abetalipoproteinemia]] or [[Wilson's disease|Wilson’s disease]]
|}


Based on histology it is classified into the non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH).NAFL mostly considered as a benign condition but recent studies show it can progress to NASH up to 44%. The more severe form of NAFLD is called non-alcoholic steatohepatitis (NASH).
==Histopathological classification==
Histological classification of NAFLD includes grading and staging.
* Grade: Depending on degree of [[steatosis]] and necro-inflammatory activity
* Stage: Depending on degree of [[fibrosis]].


One of the leading cause of cirrhosis in adults in united states is NASH. Almost 25 percent of adults with NASH may lead to cirrhosis.
===Grading===
On the other hand, NASH progress to fibrosis that can lead to cirrhosis and hepatocellular cancer (HCC).
NAFLD activity score is employed for grading steatohepatitis of NASH. NAS represents the sum of scores for [[steatosis]], lobular [[inflammation]], and ballooning.<ref name="pmid28507929">{{cite journal |vauthors=Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J |title=Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies |journal=J Clin Transl Hepatol |volume=5 |issue=1 |pages=67–75 |year=2017 |pmid=28507929 |pmc=5411359 |doi=10.14218/JCTH.2016.00061 |url=}}</ref>
Rate of progression does not correlate with body mass index (BMI) or hyperlipidemia
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
! style="background:#efefef;" |Component
! style="background:#efefef;" |Range
! style="background:#efefef;" |Score
|-
| rowspan="4" |Steatosis
|<5%
|0
|-
|5-33%
|1
|-
|34-66%
|2
|-
|>66%
|3
|-
| rowspan="4" |Lobular Inflammation
|None
|0
|-
|<2 focci
|1
|-
|2-4
|2
|-
|>4
|3
|-
| rowspan="3" |Hepatocyte -Balloning
|None
|0
|-
|Few ballooned cells
|1
|-
|Many ballooned cells
|2
|-
| rowspan="3" style="background:#efefef;" |Interpretation
| style="background:#efefef;" |0-2
| style="background:#efefef;" |Non-diagnostic
|-
| style="background:#efefef;" |3-4
| style="background:#efefef;" |Borderline
|-
| style="background:#efefef;" |5-8
| style="background:#efefef;" |Diagnostic
|}
===Staging===
Based on the degree of [[fibrosis]] on [[biopsy]] non-alochoic fatty liver disease can be classified into 4 stages.
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
! colspan="2" style="background:#efefef;" |Staging
|-
|Stage 1
|
Zone 3 [[fibrosis]]<br>
Perisinusoidal [[fibrosis]]<br>
Portal/ periportal [[fibrosis]]
|-
|Stage 2
|Perisinusoidal and portal/periportal fibrosis
|-
|Stage 3
|Bridging [[fibrosis]]
|-
|Stage 4
|[[Cirrhosis]]
|}


==References==
==References==

Latest revision as of 13:57, 27 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Non-alcoholic fatty liver (NAFLD) disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis.

Clinical Classification

Non-alcoholic fatty liver disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis.[1][2][3]

Based on clinical presentation
Non-alcoholic fatty liver Non-alcoholic steatohepatitis
  • Benign
  • Aggressive
  • Non-progressive
Based on Etiology
  • Primary NAFLD
  • If the cause of the liver disease was unknown.
  • Secondary NAFLD

Histopathological classification

Histological classification of NAFLD includes grading and staging.

  • Grade: Depending on degree of steatosis and necro-inflammatory activity
  • Stage: Depending on degree of fibrosis.

Grading

NAFLD activity score is employed for grading steatohepatitis of NASH. NAS represents the sum of scores for steatosis, lobular inflammation, and ballooning.[4]

Component Range Score
Steatosis <5% 0
5-33% 1
34-66% 2
>66% 3
Lobular Inflammation None 0
<2 focci 1
2-4 2
>4 3
Hepatocyte -Balloning None 0
Few ballooned cells 1
Many ballooned cells 2
Interpretation 0-2 Non-diagnostic
3-4 Borderline
5-8 Diagnostic

Staging

Based on the degree of fibrosis on biopsy non-alochoic fatty liver disease can be classified into 4 stages.

Staging
Stage 1

Zone 3 fibrosis
Perisinusoidal fibrosis
Portal/ periportal fibrosis

Stage 2 Perisinusoidal and portal/periportal fibrosis
Stage 3 Bridging fibrosis
Stage 4 Cirrhosis

References

  1. ↑ Hashimoto E, Tokushige K, Ludwig J (2015). "Diagnosis and classification of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: Current concepts and remaining challenges". Hepatol Res. 45 (1): 20–8. doi:10.1111/hepr.12333. PMID 24661406.
  2. ↑ Cobbina E, Akhlaghi F (2017). "Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters". Drug Metab Rev. 49 (2): 197–211. doi:10.1080/03602532.2017.1293683. PMC 5576152. PMID 28303724.
  3. ↑ Monteiro JM, Monteiro GM, Caroli-Bottino A, Pannain VL (2014). "Nonalcoholic fatty liver disease: different classifications concordance and relationship between degrees of morphological features and spectrum of the disease". Anal Cell Pathol (Amst). 2014: 526979. doi:10.1155/2014/526979. PMC 4333905. PMID 25763333.
  4. ↑ Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J (2017). "Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies". J Clin Transl Hepatol. 5 (1): 67–75. doi:10.14218/JCTH.2016.00061. PMC 5411359. PMID 28507929.

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