Non- Invasive Tests in Related to NAFLD and NASH

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Jaspreet Kaur Gujral
Busi Karunanand
Monu Sarin
Abhishek Gaurav



Because of poor eating habits, weight increase, sedentary lifestyles, "Non-alcoholic fatty liver disease" the prevalence and incidence of (NAFLD)have risen over time. This Article aims to demonstrate how biomarkers can be used as early diagnostic tools to identify (NAFLD)or, patients suffering from disease of non-alcoholic fatty liver and (NASH) or, non-alcoholic steatohepatitis as well as the patient’s subgroup with the fittest candidates for clinical trials on new compounds. NAFLD defines as the presence of hepatic steatosis of less than 5% in a histological examination without any evidence of hepatocellular injury, such as hepatocyte ballooning. It is frequently related to one or more metabolic syndrome components, such as dyslipidemia, diabetes mellitus, and obesity.

The most reliable method so far for diagnosing fatty liver(PDFF) or, proton density fat fraction generated from(MRI) or, magnetic resonance imaging. Clinical practice is the key issueinhow to make an early diagnosis of NASH. Despite a number of well-known limitations, most research on NASH confirm that point shear wave elastography or, transient elastography can help in increasing the individual number that should be tested for investigational therapy.

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How to Cite
Kaur Gujral , J. ., Karunanand, B. ., Sarin, M. ., & Gaurav, A. . (2023). Non- Invasive Tests in Related to NAFLD and NASH. Journal of Coastal Life Medicine, 11(1), 1001–1007. Retrieved from


J. A. López-Velázquez et al. The prevalence of nonalcoholic fatty liver disease in the Americas and Annals of Hepatology.2014;13 (2):166–78.

Baranova A., Younossi Z.M. The future is around the corner: Noninvasive diagnosis of progressive nonalcoholic steatohepatitis. Hepatology. 2008;47:374–375. doi: 10.1002/hep.22140.

Skelly M.M., James P.D., Ryder S.D. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J. Hepatol. 2001;35:195–199. doi: 10.1016/S0168-8278(01)00094-0.

Pendino G.M., Mariano A., Surace P., Caserta C.A., Fiorillo M.T., Amante A., Bruno S., Mangano C., Polito I., Amato F., et al. Prevalence and etiology of altered liver tests: A population-based survey in a Mediterraneantown. Hepatology. 2005;41:1151–1159. doi: 10.1002/hep.20689.

Browning J.D., Szczepaniak L.S., Dobbins R., Nuremberg P., Horton J.D., Cohen J.C., Grundy S.M., Hobbs H.H. Prevalence of hepatic steatosis in an urban population in the United States: Impact ofethnicity. Hepatology. 2004;40:1387–1395. doi: 10.1002/hep.20466.

Neuschwander-Tetri B.A., Caldwell S.H. Nonalcoholic steatohepatitis: Summary of an AASLD single topic conference. Hepatology. 2003;37:1202–1219. doi: 10.1053/jhep.2003.50193.

Sorrentino P., Tarantino G., Conca P., Perrella A., Terracciano M.L., Vecchione R., Gargiulo G., Gennarelli N., Lobello R. Silent non-alcoholic fatty liver disease-a clinical-histological study. J. Hepatol. 2004;41:751–757. doi: 10.1016/j.jhep.2004.07.010.

Fracanzani A.L., Valenti L., Bugianesi E., Andreoletti M., Colli A., Vanni E., Bertelli C., Fatta E., Bignamini D., Marchesini G., et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: A role for insulin resistance and diabetes Hepatology. 2008;48:792–798. doi: 10.1002/hep.22429.

Kotronen A., Peltonen M., Hakkarainen A., Sevastianova K., Bergholm R., Johansson L.M., Lundbom N., Rissanen A., Ridderstråle M., Groop L., et al. Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors. Gastroenterology. 2009;137:865–872. doi: 10.1053/j.gastro.2009.06.005.

Lee J.H., Kim D., Kim H.J., Lee C.H., Yang J.I., Kim W., Kim Y.J., Yoon J.H., Cho S.H., Sung M.W., et al. Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease. Dig. Liver Dis. 2010;42:503–508. doi: 10.1016/j.dld.2009.08.002.

Bedogni G., Bellentani S., Miglioli L., Masutti F., Passalacqua M., Castiglione A., Tiribelli C. The Fatty Liver Index: A simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol. 2006;6:33. doi: 10.1186/1471-230X-6-33.

Yokoo T., Byddar M., Hamilton G., Middleton M.S., Gamst A.C., Wolfson T., Hassanein T., Patton H.M., Lavine J.E., Schwimmer J.B., et al. Nonalcoholic Fatty Liver Disease: Diagnostic and Fat-Grading Accuracy of Low-Flip-Angle Multiecho Gradient-Recalled-Echo MR Imaging at 1.5 T. Radiology. 2009;251:67–76. doi: 10.1148/radiol.2511080666.

Kang G., Cruite I., Shiehmorteza M., Wolfson T., Gamst A.C., Hamilton G., Bydder M., Middleton M.S., Sirlin C.B. Reproducibility of MRI-determined proton density fat fraction across two different MR scanner platforms. J. Magn. Reson. Imaging. 2011;34:928–934. doi: 10.1002/jmri.22701.

Tang A., Tan J., Sun M., Hamilton G., Bydder M., Wolfson T., Gamst A.C., Middleton M., Brunt E.M., Loomba R., et al. Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology. 2013;267:422–431. doi: 10.1148/radiol.12120896.

Negrete L., Middleton M.S., Clark L., Wolfson T., Gamst A.C., Lam J., Changchien C., Deyoung-Dominguez I.M., Hamilton G., Loomba R., et al. Inter-examination precision of magnitude-based MRI for estimation of segmental hepatic proton density fat fraction in obese subjects. J. Magn. Reson. Imaging. 2014;39:1265–1271. doi: 10.1002/jmri.24284.

Middleton M.S., Heba E.R., Hooker C.A., Bashir M.R., Fowler K.J., Sandrasegaran K., Brunt E.M., Kleiner D.E., Doo E., Van Natta M.L., et al. Agreement between magnetic resonance imaging proton density fat fraction measurements and pathologist-assigned steatosis grades of liver biopsies from adults with non-alcoholic steatohepatitis. Gastroenterology. 2017;153:753–761. doi: 10.1053/j.gastro.2017.06.005.

Patel J., Bettencourt R., Cui J., Salotti J., Hooker J., Bhatt A., Hernandez C., Nguyen P., Aryafar H., Valasek M., et al. Association of non invasive quantitative decline in liver fat content on MRI with histologic response in nonalcoholic steatohepatitis. Ther. Adv. Gastroenterol. 2016;9:692–701. doi: 10.1177/1756283X16656735

Loomba R., Neuschwander B.A., Sanyal A., Chalasani N., Diehl A.M., Terrault N., Kowdley K., Dasarathy S., Kleiner D., Behling C., et al. Multicenter validation of association between decline in MRI-PDFF and histologic response in nonalcoholicstetohepatitis. Hepatology. 2020 doi: 10.1002/hep.31121. in press.

Sasso M., Tengher-Barna I., Ziol M., Miette V., Fournier C., Sandrin L., Poupon R., Cardoso A.C., Marcellin P., Douvin C., et al. Novel controlled attenuation parameter for noninvasive assessment of steatosis using Fibroscan (R): Validation in chronic hepatitis C. J. Viral Hepat. 2012;19:244–253. doi: 10.1111/j.1365-2893.2011.01534.x.

Karlas T., Petroff D., Sasso M., Fan J.G., Mi Y.Q., de Lédinghen V., Kumar M., Lupsor-Platon M., Han K.H., Cardoso A.C., et al. Individual patients data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J. Hepatol. 2017;66:1022–1030. doi: 10.1016/j.jhep.2016.12.022.

De Ledinghen V., Wong G., Vergniol J., Chan H.L., Hiriart J.B., Chan A.W., Chermak F., Choi P.C., Foucher J., Chan C.K., et al. Controlled attenuation parameter for the diagnosis of steatosis in nonalcoholic fatty liver disease. J. Gastroenterol. Hepatol. 2016;31:848–855. doi: 10.1111/jgh.13219.

Boursier J., Fraysse J., Lafuma A., Torreton E., Ozbay A.B. Increased healthcare resource utilization and costs in non-acoholic fatty liver disease/non-acoholicsteatohepatitis patients with liver disease progression: A multivariate analysis of french national hospital care. J. Hepatol. 2019;70:e1–e44.

Cusi K., Chang Z., Harrison S., Lomonaco R., Bril F., Orsak B., Ortiz-Lopez C., Hecht J., Feldstein A.E., Webb A., et al. Limited value of plasma cytokeratin-18 as a biomarker for NASH and fibrosis in aptients with non-alcoholic fatty liver disease. J. Hepatol. 2014;60:167–174. doi: 10.1016/j.jhep.2013.07.042.

Poynard T., Ratziu V., Charlotte F., Messous D., Munteanu M., Imbert-Bismut F., Massard J., Bonyhay L., Tahiri M., Thabut D., et al. Diagnostic value of biochemical markers (NAShTest) for the prediction of nonalcoholic steatohepatitis in patients with non alcoholic fatty liver 2006. BMC Gastroenterol. 2006;10:6–34.

Dowman J.K., Tomlinson J.W., Newsome P.N. Systematic review: The diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment. Pharmacol. Ther. 2011;33:525–540. doi: 10.1111/j.1365-2036.2010.04556.x

Adams L.A., Feldstein A.E. Non-invasive diagnosis of nonalcoholic fatty liver and nonalcoholic steatohepatitis. J. Dig. Dis. 2011;12:10–16. doi: 10.1111/j.1751-2980.2010.00471.x.

Younossi Z.M., Jarrar M., Nugent C., Randhawa M., Afendy M., Stepanova M., Rafiq N., Goodman Z., Chandhoke V., Baranova A. A novel diagnostic biomarker panel for obesity-related nonalcholic steatohepatitis (NASH) Obes. Surg. 2008;18:1430–1437. doi: 10.1007/s11695-008-9506-y.

Rosenberg W.M., Voelker M., Thiel R., Becka M., Burt A., Schuppan D., Hubscher S., Roskams T., Pinzani M., Arthur M.J. Serum markers detect the presence of liver fibrosis: A cohort study. Gastroenterology. 2004;127:1704–1713.doi: 10.1053/j.gastro.2004.08.052.

Romeo S., Kozlitina J., Xing C., Pertsemlidis A., Cox D., Pennacchio L.A., Boerwinkle E., Cohen J.C., Hobbs H.H. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat. Genet. 2008;40:1461–1465. doi: 10.1038/ng.257.

Kozlitina J., Smagris E., Stender S., Nordestgaard B.G., Zhou H.H., Tybjærg-Hansen A., Vogt T.F., Hobbs H.H., Cohen J.C. Exome-wide association study identifies a TM6SF2 variant that confers susceptibility to nonalcoholic fatty liver disease. Nat. Genet. 2014;46:352–356. doi: 10.1038/ng.2901.

Mancina R., Dongiovanni P., Petta S., Pingitore P., Meroni M., Rametta R., Borén J., Montalcini T., Pujia A., Wiklund O., et al. The MBOAT7-TMC4 Variant rs641738 Increases Risk of Nonalcoholic Fatty Liver Disease in Individuals of European Descent. Gastroenterology. 2016;150:1219–1230. doi: 10.1053/j.gastro.2016.01.032

Eslam M., Valenti L., Romeo S. Genetics and epigenetics of NAFLD and NASH. J. Hepatol. 2018;68:268–279. doi: 10.1016/j.jhep.2017.09.003

Younossi Z.M., Baranova A., Ziegler K., Del Giacco L., Schlauch K., Born T.L., Elariny H., Gorreta F., VanMeter A., Younoszai A., et al. A genomic and proteomic study of the spectrum of non-alcoholic fatty liver disease. Hepatology. 2005;25:760–771.

Charlton M., Viker K., Krishnan A., Sanderson S., Veldt B., Kaalsbeek A.J., Kendrick M., Thompson G., Que F., Swain J., et al. Differential expression of lumican and fatty acid binding protein-1-New insights into the histologic spectrum of non-alcoholic fatty liver disease. Hepatology. 2009;49:1375–1384. doi: 10.1002/hep.22927.

Bell L.N., Theodorakis J.L., Vuppalanchi R., Saxena R., Bemis K.G., Wang M., Chalasani N. Serum proteomics and biomarker discovery across the spectrum of nonalcoholic fatty liver disease. Hepatology. 2010;51:111–120. doi: 10.1002/hep.23271.

Bell L.N., Vuppalanchi R., Watkins P.B., Bonkovsky H.L., Serrano J., Fontana R.J., Wang M., Rochon J., Chalasani N. Serum proteomic profiling in patiets with drug-induced liver injury. Aliment. Pharmacol. Ther. 2012;35:600–612. doi: 10.1111/j.1365-2036.2011.04982.x

Yu C., Xu C., Xu L., Yu J., Miao M., Li Y. Serum proteomic analy- sis revealed diagnostic value of hemoglobin for nonalcoholic fatty liver disease. J. Hepatol. 2012;56:241–247. doi: 10.1016/j.jhep.2011.05.027.

Suwen Q., Depeng X., Qiaoliang L., Xie N., Xia J., Huo Q., Li P., Chen Q. Metabolomics screening of serum identifies pyroglutamate as a diagnostic biomarker for nonalcoholic steatohepatitis. Clin. Chim. Acta. 2017;473:89–95.