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In Gut, Loomba and Adams refer to the recent advances in non-invasive assessment of hepatic fibrosis.1 Not surprisingly, many recent studies in the field were conducted in patients at risk or with clinically diagnosed non-alcoholic fatty liver disease (NAFLD). The implications of non-invasive testing are particularly far reaching in this group of patients since this disease affects 25% of Western populations. The principal need to identify the small subset of NAFLD patients at-risk of progressive disease and liver-related outcomes is obvious.
Recent retrospective longitudinal studies have shown that non-alcoholic steatohepatitis (NASH) is not an independent predictor of liver-related complication or mortality in NAFLD.2 3 NASH is a risk factor of fibrosis progression rather than an immediate risk of liver related complication and therefore positions at a lower prognostic significance in the hierarchical model of NAFLD.4 The diagnosis of NASH still requires a liver biopsy, a procedure not suitable for the very large NAFLD population because it is invasive and not widely accepted among non-specialised physicians and patients. No non-invasive test (NIT) has so far achieved enough accuracy and validation for the non-invasive diagnosis of NASH. One explanation is that most of the known candidate blood markers for NASH are not specific of the liver and could be produced by other organs, especially the expanded adipose tissue observed in NAFLD. Moreover, liver biopsy results are limited by a fairly high discordance …
Contributors Both authors have written the manuscript and drawn the figure together.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed.