Alimentary Pharmacology and Therapeutics

Invited Editorials Editorial: when and how to use steatosis biomarkers? V. W.-S. Wong*,†,‡ & G. L.-H. Wong*,†,‡ *Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. † Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. ‡ State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. E-mail: [email protected] doi:10.1111/apt.12983

Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of abnormal liver biochemistry. At the clinic setting, the diagnosis is usually based on typical bright liver echotexture with deep attenuation, after judicious exclusion of other liver diseases. When more than one-third of the hepatocytes are steatotic, the sensitivity of ultrasonography exceeds 90%.1 Magnetic resonance spectroscopy and fat-water magnetic resonance imaging are sensitive even for mild steatosis and can quantify steatosis, but are limited by availability and costs.2, 3 The situation is different at the population setting. Even ultrasonography may be too labour-intensive and expensive. Therefore, there has been much interest in developing simple steatosis biomarkers to diagnose NAFLD. Routine tests like alanine aminotransferase have poor diagnostic performance and correlate poorly with histological severity.4 Recently, Fedchuk et al. evaluated the diagnostic performance of five steatosis biomarker indexes in 324 patients who underwent liver biopsy for suspected NAFLD.5 The panels were fatty liver index, NAFLD liver fat score (NAFLD-LFS), hepatic steatosis index, visceral adiposity index and triglyceride 9 glucose index. Overall, all 5 indexes had good accuracy in detecting ≥5% steatosis, with areas under the receiver-operating characteristics curve ranging from 0.80 to 0.92. However,

they were poor in distinguishing among different steatosis grades and diagnosing moderate to severe steatosis. This study has the strength of a large sample size and the use of histology as the reference standard. However, because all patients underwent liver biopsy for suspected NAFLD, only 15 patients had steatosis

When and how to use steatosis biomarkers?

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