Non-alcoholic fatty liver disease classification

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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	Can progress to cirrhosis Rarely can give rise to hepatocellular carcinoma
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

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

↑ 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.
↑ 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.
↑ 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.
↑ 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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[pmid24661406-1] 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.

[pmid28303724-2] 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.

[pmid25763333-3] 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.

[pmid28507929-4] 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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