Department of Medical and Surgical Sciences (DIMEC), Division of Internal Medicine, University of Bologna, Bologna 40136, Italy.
World J Gastroenterol. 2018 Aug 14;24(30):3361-3373. doi: 10.3748/wjg.v24.i30.3361.
The current epidemic of non-alcoholic fatty liver disease (NAFLD) is reshaping the field of hepatology all around the world. The widespread diffusion of metabolic risk factors such as obesity, type2-diabetes mellitus, and dyslipidemia has led to a worldwide diffusion of NAFLD. In parallel to the increased availability of effective anti-viral agents, NAFLD is rapidly becoming the most common cause of chronic liver disease in Western Countries, and a similar trend is expected in Eastern Countries in the next years. This epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis, management, and treatment of NAFLD. Different scientific societies from Europe, America, and Asia-Pacific regions have proposed guidelines based on the most recent evidence about NAFLD. These guidelines are consistent with the key elements in the management of NAFLD, but still, show significant difference about some critical points. We reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main differences. We distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical regions. Differences were noted in: the definition of NAFLD, the opportunity of NAFLD screening in high-risk patients, the non-invasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis, in the follow-up protocols and, finally, in the treatment strategy (especially in the proposed pharmacological management). These difference have been discussed in the light of the possible evolution of the scenario of NAFLD in the next years.
目前，非酒精性脂肪性肝病（NAFLD）的流行正在重塑全球范围内的肝脏病学领域。肥胖、2 型糖尿病和血脂异常等代谢危险因素的广泛传播，导致 NAFLD 在全球范围内扩散。随着有效的抗病毒药物的广泛应用，NAFLD 迅速成为西方国家慢性肝病的最常见原因，预计在未来几年，这种趋势也将在东方国家出现。这种流行及其后果促使来自世界各地的专家确定了 NAFLD 的诊断、管理和治疗的有效策略。来自欧洲、美洲和亚太地区的不同科学协会根据 NAFLD 的最新证据提出了指南。这些指南与 NAFLD 管理的关键要素一致，但在一些关键问题上仍存在显著差异。我们回顾了英文文献，以确定关于 NAFLD 的最新科学指南，旨在发现和批判性分析主要差异。我们区分了来自 5 个不同科学协会的指南，这些协会在全球范围内享有盛誉，代表了不同地理区域的临床实践。差异主要体现在：NAFLD 的定义、高危患者的 NAFLD 筛查机会、用于诊断 NAFLD 的非侵入性检测以及识别有进展性纤维化的 NAFLD 患者、随访方案，最后是治疗策略（特别是在建议的药物治疗管理方面）。这些差异是根据未来几年 NAFLD 可能的发展情况进行讨论的。
