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]Parth Vikram Singh, MBBS[3]
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 |
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| Based on Etiology | |
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Steatotic liver disease may be subclassified according to the presence of cardiometabolic risk factors, alcohol intake, and other causes of hepatic steatosis.[4]
| Category | Definition |
|---|---|
| MASLD | Hepatic steatosis with at least 1 cardiometabolic risk factor, alcohol intake less than 140 g/week in women and less than 210 g/week in men, and no other known cause of hepatic steatosis |
| Metabolic dysfunction and alcohol-related liver disease (MetALD) | Hepatic steatosis with metabolic dysfunction and alcohol intake of 140-350 g/week in women or 210-420 g/week in men |
| Alcohol-associated liver disease | Alcohol intake greater than 350 g/week in women or greater than 420 g/week in men |
| Cryptogenic steatotic liver disease | Hepatic steatosis without cardiometabolic risk factors and without an identifiable cause |
| Specific-etiology steatotic liver disease | Hepatic steatosis due to another identifiable cause, such as drug-induced liver injury, iron overload, genotype 3 hepatitis C, Wilson disease, lysosomal acid lipase deficiency, hypobetalipoproteinemia, inborn errors of metabolism, celiac disease, malnutrition, or HIV infection |
One standard drink is approximately equivalent to 10 g of alcohol, corresponding approximately to 12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof distilled spirits.
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.[5]
| 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 liver biopsy histology, liver fibrosis in MASLD is scored using a 5-stage scale:
| Stage | Histologic description |
| F0 | Absence of fibrosis |
| F1 | Perisinusoidal or portal fibrosis |
| F2 | Perisinusoidal and portal or periportal fibrosis |
| F3 | Septal and bridging fibrosis |
| F4 | 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.
- ↑ Tilg H, Petta S, Stefan N, Targher G (January 2026). "Metabolic Dysfunction-Associated Steatotic Liver Disease in Adults: A Review". JAMA. 335 (2): 163–174. doi:10.1001/jama.2025.19615. PMID 41212550 Check
|pmid=value (help). - ↑ 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.