FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic
Yoshio Sumida,
Masashi Yoneda,
Katsutoshi Tokushige,
Miwa Kawanaka,
Hideki Fujii,
Masato Yoneda,
Kento Imajo,
Hirokazu Takahashi,
Yuichiro Eguchi,
Masafumi Ono,
Yuichi Nozaki,
Hideyuki Hyogo,
Masahiro Koseki,
Yuichi Yoshida,
Takumi Kawaguchi,
Yoshihiro Kamada,
Takeshi Okanoue,
Atsushi Nakajima,
Japan Study Group of NAFLD (JSG-NAFLD)
Affiliations
Yoshio Sumida
Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
Masashi Yoneda
Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
Katsutoshi Tokushige
Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
Miwa Kawanaka
Department of General Internal Medicine2, Kawasaki Medical School, Okayama 700-8505, Japan
Hideki Fujii
Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka 558-8585, Japan
Masato Yoneda
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
Kento Imajo
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
Hirokazu Takahashi
Department of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 840-8502, Japan
Yuichiro Eguchi
Loco Medical General Institute, Saga 840-8502, Japan
Masafumi Ono
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo 116-8567, Japan
Yuichi Nozaki
Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Hideyuki Hyogo
Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima 738-8503, Japan
Masahiro Koseki
Division of Cardiovascular Medicine, Department of Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
Yuichi Yoshida
Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka 564-8567, Japan
Takumi Kawaguchi
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
Yoshihiro Kamada
Department of Advanced Gastroenterology & Hepatology, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
Takeshi Okanoue
Hepatology Center, Saiseikai Suita Hospital, Osaka 564-0013, Japan
Atsushi Nakajima
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
Japan Study Group of NAFLD (JSG-NAFLD)
Japan Strategic Medical Administration Research Center (J-SMARC), Nagoya, Aichi 460-0011, Japan
The prevalence of obesity or metabolic syndrome is increasing worldwide (globally metabodemic). Approximately 25% of the adult general population is suffering from nonalcoholic fatty liver disease (NAFLD), which has become a serious health problem. In 2020, global experts suggested that the nomenclature of NAFLD should be updated to metabolic-dysfunction-associated fatty liver disease (MAFLD). Hepatic fibrosis is the most significant determinant of all cause- and liver -related mortality in MAFLD. The non-invasive test (NIT) is urgently required to evaluate hepatic fibrosis in MAFLD. The fibrosis-4 (FIB-4) index is the first triaging tool for excluding advanced fibrosis because of its accuracy, simplicity, and cheapness, especially for general physicians or endocrinologists, although the FIB-4 index has several drawbacks. Accumulating evidence has suggested that vibration-controlled transient elastography (VCTE) and the enhanced liver fibrosis (ELF) test may become useful as the second step after triaging by the FIB-4 index. The leading cause of mortality in MAFLD is cardiovascular disease (CVD), extrahepatic malignancy, and liver-related diseases. MAFLD often complicates chronic kidney disease (CKD), resulting in increased simultaneous liver kidney transplantation. The FIB-4 index could be a predictor of not only liver-related mortality and incident hepatocellular carcinoma, but also prevalent and incident CKD, CVD, and extrahepatic malignancy. Although NITs as milestones for evaluating treatment efficacy have never been established, the FIB-4 index is expected to reflect histological hepatic fibrosis after treatment in several longitudinal studies. We here review the role of the FIB-4 index in the management of MAFLD.
