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Non-alcoholic fatty liver disease: non-invasive investigation and risk stratification

Lookup NU author(s): Dr Jess Dyson, Professor Stuart McPhersonORCiD, Professor Quentin AnsteeORCiD


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Non-alcoholic fatty liver disease (NAFLD) encompasses a histological spectrum of liver disease, from simple steatosis through to cirrhosis. As the worldwide rates of obesity have increased, NAFLD has become the commonest cause of liver disease in many developed countries, affecting up to a third of the population. The majority of patients have simple steatosis that carries a relatively benign prognosis. However, a significant minority have non-alcoholic steatohepatitis, and have increased liver related and cardiovascular mortality. Identifying those at risk of progressive disease is crucial. Liver biopsy remains the gold standard investigation for assessing stage of disease but its invasive nature makes it impractical for widespread use as a prognostic tool. Non-invasive tools for diagnosis and disease staging are required, reserving liver biopsy for those patients where it offers clinically relevant additional information. This review discusses the non-invasive modalities available for assessing steatosis, steatohepatitis and fibrosis. We propose a pragmatic approach for the assessment of patients with NAFLD to identify those at high risk of progressive disease who require referral to specialist services.

Publication metadata

Author(s): Dyson JK, McPherson S, Anstee QM

Publication type: Review

Publication status: Published

Journal: Postgraduate Medical Journal

Year: 2014

Volume: 90

Issue: 1063

Pages: 254-266

Print publication date: 01/05/2014

ISSN (print): 0032-5473

ISSN (electronic): 1469-0756



DOI: 10.1136/postgradmedj-2013-201620rep