Life (Feb 2021)

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)

DOI
https://doi.org/10.3390/life11020143
Journal volume & issue
Vol. 11, no. 2
p. 143

Abstract

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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.

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