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==
* Based on histology it is classified into the non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH).
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>
* NAFL mostly considered as a benign condition but recent studies show it can progress to NASH up to 44%.  
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
* The more severe form of NAFLD is called non-alcoholic steatohepatitis (NASH).
! colspan="2" style="background:#efefef;" |Based on clinical presentation
* 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.
|-
* On the other hand, NASH progress to fibrosis that can lead to cirrhosis and hepatocellular cancer (HCC).
! style="background:#efefef;" |Non-alcoholic fatty liver
* Rate of progression does not correlate with body mass index (BMI) or hyperlipidemia
! 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]]
|}
 
==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.<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>
{| 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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