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. 2016 Sep 28;22(36):8226-33.
doi: 10.3748/wjg.v22.i36.8226.

Clinical guidelines of non-alcoholic fatty liver disease: A systematic review

Jin-Zhou Zhu  1 , Kelseanna Hollis-Hansen  1 , Xing-Yong Wan  1 , Su-Juan Fei  1 , Xun-Lei Pang  1 , Fan-Dong Meng  1 , Chao-Hui Yu  1 , You-Ming Li  1
Affiliations

Clinical guidelines of non-alcoholic fatty liver disease: A systematic review

Jin-Zhou Zhu et al. World J Gastroenterol. .

Abstract

Aim: To perform a systematic review to grade guidelines and present recommendations for clinical management of non-alcoholic fatty liver disease (NAFLD).

Methods: A database search was conducted on PubMed for guidelines published before May 2016, supplemented by reviewing relevant websites. The Appraisal of Guidelines for Research and Evaluation (ARGEE) Instrument II was a tool designed to appraise the methodological rigor and transparency in which a clinical guideline is developed and it is used internationally. It was used to appraise the quality of guidelines in this study. The inclusion criteria include: clinical NAFLD guidelines for adults, published in English, and released by governmental agencies or key organizations.

Results: Eleven guidelines were included in this study. Since 2007, guidelines have been released in Asia (3 in China, 1 in South Korea, and 1 in Japan), Europe (1 in Italy), America (1 in United States and 1 in Chile) and three international agencies [European associations joint, Asia-Pacific Working Party and World Gastroenterology Organization (WGO)]. Using the ARGEE II instrument, we found US 2012 and Europe 2016 had the highest scores, especially in the areas of rigor of development and applicability. Additionally, Italy 2010 and Korea 2013 also presented comprehensive content, rigorous procedures and good applicability. And WGO 2014 offered various algorithms for clinical practice. Lastly, a practical algorithm for the clinical management was developed, based on the recommended guidelines.

Conclusion: This is the first systematic review of NAFLD guidelines. It may yield insights for physicians and policy-makers in the development and application of guidelines.

Keywords: Diagnosis; Management; Non-alcoholic fatty liver disease; Systematic review; Treatment.

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Conflict of interest statement

Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.

Figures

Figure 1
Figure 1
Flow chart of guidelines searching.
Figure 2
Figure 2
Domain scores for each guideline based on the Appraisal of Guidelines for Research and Evaluation II Instrument. A-C: Each Appraisal of Guidelines for Research and Evaluation II domain score for guidelines is presented on the X-axis as a percentage of 100 (0% = the domain was not at all satisfied; and 100% = fully satisfied). D: Overall scores for guidelines. WGO: World Gastroenterology Organization.
Figure 3
Figure 3
Clinical algorithm for the diagnosis and management of non-alcoholic fatty liver disease in adults. The algorithm was developed according to United States 12[1], WGO 14[13] and Europe 16[2]. 1H-MRS: Proton magnetic resonance spectroscopy; ALT: Alanine transaminase; AST: Aspartate transaminase; BMI: Body mass index; CT: Computed tomography; FPG: Fasting plasma glucose; FXR: Farnesoid X receptor; GGT: Gamma-glutamyltransferase; HbA1c: Hemoglobin a1c; HOMA-IR: Homeostasis model assessment of insulin resistance; MRI: Magnetic resonance imaging; WHR: Waist-to-hip ratio; WGO: World Gastroenterology Organization; NAFLD: Non-alcoholic fatty liver disease.
See this image and copyright information in PMC

References

    1. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55:2005–2023. - PubMed
    1. European Association for the Study of the Liver (EASL) Electronic address: easloffice@easloffice.eu; European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64:1388–1402. - PubMed
    1. Marchesini G, Petta S, Dalle Grave R. Diet, weight loss, and liver health in nonalcoholic fatty liver disease: Pathophysiology, evidence, and practice. Hepatology. 2016;63:2032–2043. - PubMed
    1. Birkenfeld AL, Shulman GI. Nonalcoholic fatty liver disease, hepatic insulin resistance, and type 2 diabetes. Hepatology. 2014;59:713–723. - PMC - PubMed
    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. - PubMed

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