Non-alcoholic fatty liver disease: current diagnostic opportunities at different stages of the disease and scientific developments in treatment. Review

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a widespread disease and a major challenge for health care systems worldwide. Disease severity and end‑stage disease vary considerably among patients, so there is a need to identify those at greatest risk of disease progression. NAFLD is often asymptomatic, but should be suspected in individuals with risk factors. Marked liver fibrosis is the strongest predictor of long‑term mortality in patients with NAFLD and is one of the risk factors for the development of hepatocellular carcinoma (HCC). Liver biopsies are the gold standard for diagnosing the stage of liver fibrosis. However, this is an invasive procedure that cannot be widely used in a daily clinical practice. Therefore, there is a constant search for non‑invasive and safe biomarkers.
 The purpose of this publication is to analyze and summarize the current research results of non‑invasive tests for fibrosis, as well as scientific developments in the NAFLD treatment, which can be widely used in daily clinical practice. Non‑invasive methods of diagnosing liver fibrosis can be divided into biochemical serum tests (serological) and morphological. Serum markers of fibrosis are studied based on participation in the mechanisms of fibrogenesis and fibrolysis. The authors outlined the effectiveness of different scales including different markers of fibrosis, but for widespread use in clinical practice, it is recommended to use simple and accessible tests and scales. One of the modern and safe instrumental diagnostic methods is transient elastography, which has excellent effectiveness for diagnosing liver fibrosis, predicting the development of HCC and other clinical stages. Two‑dimensional shear wave elastography is a new technique that provides real‑time imaging of stiffness. Further studies are needed to establish specific markers of liver fibrosis based on further clinical and molecular studies.
 Recommendations for patients’ lifestyle changing with individualized approach to the non‑drug treatment administration are stated to be important for curation of patients with NAFLD. If patients adhere to such recommendations, the overall benefit for NAFLD regression and health can be quite significant. However, due to the insufficient compliance of some patients with non‑drug treatment, a constant search for candidate molecules for NAFLD treatment is conducted. At the current stage, there are no approved recommendations for drug treatment, thus the research in this direction is ongoing. The article provides up‑to‑date information on the stages of studying the main existing molecules