Noninvasive assessment of liver fibrosis in NAFLD

Sanyal, Arun J.; Castera, Laurent; Wong, Vincent Wai-Sun

doi:10.1016/j.cgh.2023.03.042

Cited by 157Liver Disease Diagnosis and TreatmentLiver Disease and TransplantationLiver Diseases and Immunity

Noninvasive assessment of liver fibrosis in NAFLD

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Sanyal, Arun J., Castera, Laurent, Wong, Vincent Wai-Sun·2023·Clinical Gastroenterology and Hepatology

DOI 10.1016/j.cgh.2023.03.042

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Abstract

Nonalcoholic fatty liver disease (NAFLD) has emerged as a leading cause of liver-related morbidity and mortality worldwide, afflicting approximately a billion individuals. NAFLD is a slowly progressive disease that may evolve in a subset of patients toward cirrhosis, hepatocellular carcinoma, and end-stage liver disease. Liver fibrosis severity is the strongest predictor of clinical outcomes. The emergence of effective therapeutics on the horizon highlights the need to identify among patients with NAFLD, those with severe fibrosis or cirrhosis, who are the most at risk of developing complications and target them for therapy. Liver biopsy has been the reference standard for this purpose. However, it is not suitable for large-scale population evaluation, given its well-known limitations (invasiveness, rare but severe complications, and sampling variability). Thus, there have been major efforts to develop simple noninvasive tools that can be used in routine clinical settings and in drug development. Noninvasive approaches are based on the quantification of biomarkers in serum samples or on the measurement of liver stiffness, using either ultrasound- or magnetic resonance-based elastography techniques. This review provides a roadmap for future development and integration of noninvasive tools in clinical practice and in drug development in NAFLD. We discuss herein the principles for their development and validation, their use in clinical practice, including for diagnosis of NAFLD, risk stratification in primary care and hepatology settings, prediction of long-term liver-related and non-liver-related outcomes, monitoring of fibrosis progression and regression, and response to future treatment.

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To date, these surrogates have not been unambiguously linked to true clinical benefits (e.g. liver-related mortality).
“However, to date, these surrogates have not been unambiguously linked to true clinical bene fi ts ( e.g. liver-related mortality). 257”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [257]

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Wong, V. W., Zelber‐Sagi, S., Cusi, K. J., Carrieri, P., Wright, E. E., Crespo, J., & Lazarus, J. V. (2022) · Liver International · doi:10.1111/liv.15404 · Cited by 82 · see citing works
Serial Transient Elastography Examinations to Monitor Patients With Type 2 Diabetes: A Prospective Cohort Study
Lee, H. W., Wong, G. L., Kwok, R., Choi, K. C., Chan, C. K., Shu, S. S., Leung, J. K., Chim, A. M., Luk, A. O. Y., Ronald, C. W., et al. (2020) · Hepatology · doi:10.1002/hep.31142 · Cited by 80 · see citing works
Non-invasive fibrosis scoring systems can predict future metabolic complications and overall mortality in non-alcoholic fatty liver disease (NAFLD)
Önnerhag, K., Hartman, H., Nilsson, P. M., & Lindgren, S. C. (2019) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2019.1583366 · Cited by 76 · see citing works
MR elastography‐based liver fibrosis correlates with liver events in nonalcoholic fatty liver patients: A multicenter study
Han, M. A. T., Vipani, A., Noureddin, N., Ramirez, K., GORNBEIN, J. A., Saouaf, R., Baniesh, N., Cummings-John, O. D., Okubote, T. C., Setiawan, V. W., et al. (2020) · Liver International · doi:10.1111/liv.14593 · Cited by 75 · see citing works
Longitudinal association of magnetic resonance elastography‐associated liver stiffness with complications and mortality
Higuchi, M., Tamaki, N., Kurosaki, M., Inada, K., Kirino, S., Yamashita, K., Hayakawa, Y., Osawa, L., Takaura, K., Maeyashiki, C., et al. (2021) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16745 · Cited by 65 · see citing works
Relationship between three commonly used non‐invasive fibrosis biomarkers and improvement in fibrosis stage in patients with non‐alcoholic steatohepatitis
Chalasani, N., Abdelmalek, M. F., Loomba, R. S., Kowdley, K. V., McCullough, A. J., Dasarathy, S., Neuschwander‐Tetri, B. A., Terrault, N. A., Ferguson, B., Shringarpure, R., et al. (2018) · Liver International · doi:10.1111/liv.13974 · Cited by 58 · see citing works
Structured Early detection of Asymptomatic Liver Cirrhosis: Results of the population-based liver screening program SEAL
Labenz, C., Arslanow, A., Nguyen-Tat, M., Nagel, M., Wörns, M., Reichert, M., Heil, F. J., Mainz, D., Zimper, G., Römer, B., et al. (2022) · Journal of Hepatology · doi:10.1016/j.jhep.2022.04.009 · Cited by 58 · see citing works
FibroMeters: a family of blood tests for liver fibrosis
Calès, P., Boursier, J., Oberti, F., Hubert, I., Gallois, Y., Rousselet, M., Dib, N., Moal, V., Macchi, L., Chevailler, A., et al. (2008) · Gastroentérologie Clinique et Biologique · doi:10.1016/s0399-8320(08)73992-7 · Cited by 55 · see citing works
Diagnostic Accuracy of Noninvasive Fibrosis Scores in a Population of Individuals With a Low Prevalence of Fibrosis
Mahady, S. E., Macaskill, P., Craig, J. C., Wong, G. L., Chu, C. W., Chan, H. L., George, J., & Wong, V. W. (2017) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2017.02.031 · Cited by 52 · see citing works
Long-term prognostic value of the FibroTest in patients with non-alcoholic fatty liver disease, compared to chronic hepatitis C, B, and alcoholic liver disease
Munteanu, M., Pais, R., Peta, V., Deckmyn, O., Moussalli, J., Ngo, Y., Rudler, M., Lebray, P., Charlotte, F., Thibault, V., et al. (2018) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.14990 · Cited by 42 · see citing works
Performance of American Gastroenterological Association Clinical Care Pathway for the risk stratification of patients with nonalcoholic fatty liver disease in the US population
Udompap, P., Therneau, T. M., Canning, R. E., Benson, J. T., & Allen, A. M. (2023) · Hepatology · doi:10.1002/hep.32739 · Cited by 37 · see citing works
Genetics of alcoholic liver disease and non-alcoholic steatohepatitis
Scott, E., & Anstee, Q. M. (2018) · Clinical Medicine · doi:10.7861/clinmedicine.18-2-s54 · Cited by 33 · see citing works
Liver stiffness (Fibroscan®) is a predictor of all‐cause mortality in people with non‐alcoholic fatty liver disease
Braude, M. R., Roberts, S. K., Majeed, A., Lubel, J. S., Prompen, J., Dev, A. T., Sievert, W., Bloom, S., Gow, P. J., & Kemp, W. W. (2022) · Liver International · doi:10.1111/liv.15415 · Cited by 29 · see citing works
Repeated measurements of non‐invasive fibrosis tests to monitor the progression of non‐alcoholic fatty liver disease: A long‐term follow‐up study
Balkhed, W., Åberg, F. O., Nasr, P., Ekstedt, M., & Kechagias, S. (2022) · Liver International · doi:10.1111/liv.15255 · Cited by 23 · see citing works
Prognostic non-invasive biomarkers for all-cause mortality in non-alcoholic fatty liver disease: A systematic review and meta-analysis
Cianci, N., Subhani, M., Hill, T., Khanna, A., Zheng, D., Sheth, A., Crooks, C. J., & Aithal, G. P. (2022) · World Journal of Hepatology · doi:10.4254/wjh.v14.i5.1025 · Cited by 17 · see citing works
Biomarker validation with an imperfect reference: Issues and bounds
Emerson, S. C., Waikar, S. S., Fuentes, C., Bonventre, J. V., & Betensky, R. A. (2017) · Statistical Methods in Medical Research · doi:10.1177/0962280216689806 · Cited by 12 · see citing works

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EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD).
Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210 · see citing works
Epidemiology of metabolic dysfunction-associated steatotic liver disease
Younossi, Z. M., Kalligeros, M., & Henry, L. (2025) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2024.0431 · Cited by 960 · see citing works
EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
(2024) · Obesity Facts · doi:10.1159/000539371 · Cited by 510 · see citing works
Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) in People With Diabetes: The Need for Screening and Early Intervention. A Consensus Report of the American Diabetes Association
Cusi, K. J., Abdelmalek, M. F., Apovian, C. M., Balapattabi, K., Bannuru, R. R., Barb, D., Bardsley, J. K., Beverly, E. A., Corbin, K. D., ElSayed, N. A., et al. (2025) · Diabetes Care · doi:10.2337/dci24-0094 · Cited by 396 · see citing works
Vibration-controlled transient elastography scores to predict liver-related events in steatotic liver disease
Lin, H., Lee, H. W., Yip, T. C.-F., Tsochatzis, E., Petta, S., Bugianesi, E., Yoneda, M., Zheng, M.-H., Hagström, H., Boursier, J., et al. (2024) · JAMA · doi:10.1001/jama.2024.1447 · Cited by 250 · see citing works
Self-citation
Fibrosis: cross-organ biology and pathways to development of innovative drugs
Rieder, F., Nagy, L. E., Maher, T. M., Distler, J. H. W., Kramann, R., Hinz, B., & Prunotto, M. (2025) · Nature Reviews Drug Discovery · doi:10.1038/s41573-025-01158-9 · Cited by 117 · see citing works
“However, in clinical practice, non-invasive measures of fibrosis are important 326,327 .”
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease
Yip, T. C., Lee, H. W., Lin, H., Tsochatzis, E. A., Petta, S., Bugianesi, E., Yoneda, M., Zheng, M., Hagström, H., Boursier, J., et al. (2025) · Journal of Hepatology · doi:10.1016/j.jhep.2025.01.014 · Cited by 63 · see citing works
Updated recommendations for the management of metabolic dysfunction–associated steatotic liver disease (MASLD) by the Latin American working group
Díaz, L. A., Arab, J. P., Idalsoaga, F. J., Perelli, J., Vega, J. A., Dirchwolf, M., Carreño, J., Samith, B., Valério, C. M., Moreira, R. O., et al. (2025) · Annals of Hepatology · doi:10.1016/j.aohep.2025.101903 · Cited by 66 · see citing works
Fatty Liver Index (FLI) is the best score to predict MASLD with 50% lower cut-off value in women than in men
Crudele, L., Matteis, C. D., Novielli, F., Buduo, E. D., Petruzzelli, S., Giorgi, A. D., Antonica, G., Berardi, E., & Moschetta, A. (2024) · Biology of Sex Differences · doi:10.1186/s13293-024-00617-z · Cited by 62 · see citing works
“On the other hand, liver biopsy may not be considered for screening or follow-up, considering its invasiveness, rare but severe complications, sampling variability, and the need for short-term repeated evaluation in MASLD patients [11, 12].”
Background
Prospective head-to-head comparison of non-invasive scores for diagnosis of fibrotic MASH in patients with type 2 diabetes
Castéra, L., Garteiser, P., Laouenan, C., Vidal-Trécan, T., Vallet‐Pichard, A., Manchon, P., Paradis, V., Czernichow, S., Roulot, D. M., Larger, É., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.03.023 · Cited by 54 · see citing works
Targeting collagen homeostasis for the treatment of liver fibrosis: Opportunities and challenges
Luangmonkong, T., Parichatikanond, W., & Olinga, P. (2023) · Biochemical Pharmacology · doi:10.1016/j.bcp.2023.115740 · Cited by 53 · see citing works
From “Burnt-Out” to “Burning-Out”: Capturing Liver Fat Loss in Patients With Advanced Metabolic Dysfunction–Associated Steatotic Liver Disease From a Dynamic Perspective
Liu, W., Huang, S., Ji, H., Kim, S. U., Yip, T. C., Wong, G. L., Petta, S., Tsochatzis, E. A., Nakajima, A., Bugianesi, E., et al. (2025) · Gastroenterology · doi:10.1053/j.gastro.2025.02.034 · Cited by 38 · see citing works
The Janus of a disease: Diabetes and metabolic dysfunction-associated fatty liver disease
Francisco Barrera, M., Uribe, J., Olvares, N., Huerta, P., Cabrera, D., & Romero‐Gómez, M. (2024) · Annals of Hepatology · doi:10.1016/j.aohep.2024.101501 · Cited by 36 · see citing works
The Role of the Fatty Liver Index (FLI) in the Management of Non-Alcoholic Fatty Liver Disease: A Systematic Review
Biciusca, T., Stan, S. I., Bălteanu, M. A., Cioboată, R., Ghenea, A. E., Dănoiu, S., Bumbea, A. M., & Biciuşcă, V. (2023) · Diagnostics · doi:10.3390/diagnostics13213316 · Cited by 36 · see citing works
“Currently, the most effective screening methods for NAFLD and ﬁbrosis (FLI, HSI, Steatotest, FIB-4) are those based on serum biomarkers, as well as imaging methods such as transient elastography and MRI, although their cost is quite high [33].”
Background
Hepatic Fibrosis and Cancer: The Silent Threats of Metabolic Syndrome
Friedman, S. L. (2024) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2023.0240 · Cited by 37 · see citing works
“Screening approaches vary based on the country and technologies available to clinicians, but typically include use of a non-invasive score (e.g., fibrosis-4 [FIB-4] or enhanced liver fibrosis [ELF]) combined with liver stiffness (Fibroscan, Echo-sens, Paris, France) [22,23].”
Background
Accurate non-invasive detection of MASH with fibrosis F2-F3 using a lightweight machine learning model with minimal clinical and metabolomic variables
Stefanakis, K., Mingrone, G., George, J., & Mantzoros, C. S. (2024) · Metabolism · doi:10.1016/j.metabol.2024.156082 · Cited by 36 · see citing works
Role of noninvasive tests in the prognostication of metabolic dysfunction-associated steatotic liver disease
Wang, Y., Song, S. J., Jiang, Y., Lai, J. C., Wong, G. L., Wong, V. W., & Yip, T. C. (2024) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2024.0246 · Cited by 32 · see citing works
Galectin-3 and Severity of Liver Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease
Sotoudeheian, M. (2024) · Protein and Peptide Letters · doi:10.2174/0109298665301698240404061300 · Cited by 32 · see citing works
Mechanism-guided drug development and treatment for liver fibrosis: a clinical perspective
Zeng, X., Huang, D., Zhu, Z., Cai, Q., Yang, Y., Lu, H., & Chen, J. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1574385 · Cited by 32 · see citing works
Non-invasive risk-based surveillance of hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease
Lai, J. C., Yang, B., Lee, H. W., Lin, H., Tsochatzis, E. A., Petta, S., Bugianesi, E., Yoneda, M., Zheng, M., Hagström, H., et al. (2025) · Gut · doi:10.1136/gutjnl-2025-334981 · Cited by 32 · see citing works
Drivers of cardiovascular disease in metabolic dysfunction-associated steatotic liver disease: the threats of oxidative stress
Minetti, E. T., Hamburg, N. M., & Matsui, R. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1469492 · Cited by 30 · see citing works
NAFLD in the 21st Century: Current Knowledge Regarding Its Pathogenesis, Diagnosis and Therapeutics
Kounatidis, D., Vallianou, N., Geladari, E., Panoilia, M.-P., Daskou, A., Stratigou, T., Karampela, I., Tsilingiris, D., & Dalamaga, M. (2024) · Biomedicines · doi:10.3390/biomedicines12040826 · Cited by 32 · see citing works
“The NIS4 has been demonstrated to perform well for the identification of patients with “at-risk NASH” [50,53].”
BackgroundMethodInfluential
Liver fibrosis as a barometer of systemic health by gauging the risk of extrahepatic disease
Lonardo, A., Ballestri, S., Baffy, G., & Weiskirchen, R. (2024) · Metabolism and Target Organ Damage · doi:10.20517/mtod.2024.42 · Cited by 29 · see citing works
Consensus guidelines for the diagnosis and management of metabolic dysfunction-associated steatotic liver disease in adult Asian Indians with type 2 diabetes
Misra, A., Kumar, A., Kuchay, M. S., Ghosh, A., Gulati, S., Choudhary, N. S., Dutta, D., Sharma, P., Vikram, N. K., Rastogi, A., et al. (2025) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2025.103209 · Cited by 27 · see citing works
Diagnosis and non‐invasive assessment of MASLD in type 2 diabetes and obesity
Chan, W., Petta, S., Noureddin, M., Goh, G. B., & Wong, V. W. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17866 · Cited by 25 · see citing works
“74 In addition, features of two-dimensional shear wave elastography may reflect lobular inflammation and other properties of MASH.”
Background
MAFLD in adults: non-invasive tests for diagnosis and monitoring of MAFLD
Chan, W., Wong, V. W., Adams, L. A., & Nguyen, M. H. (2024) · Hepatology International · doi:10.1007/s12072-024-10661-x · Cited by 24 · see citing works
“In particular, its negative predictive value in excluding advanced fibrosis is high at over 90%, especially in low-prevalence settings such as primary care [24].”
Body Composition and Progression of Biopsy‐Proven Non‐Alcoholic Fatty Liver Disease in Patients With Obesity
Wan, Q., Liu, X., Xu, J., Zhao, R., Yang, S., Feng, J., Cao, Z., Li, J., He, X., Chen, H., et al. (2024) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13605 · Cited by 20 · see citing works
FAST and Agile–the MASLD drift: Validation of Agile 3+, Agile 4 and FAST scores in 246 biopsy-proven NAFLD patients meeting MASLD criteria of prevalent caucasian origin
Țâru, M.-G., Tefas, C., Neamți, L., Minciună, I., Țâru, V., Maniu, A., Rusu, I., Petrushev, B., Procopciuc, L. M., Leucuta, D., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0303971 · Cited by 20 · see citing works
Advances in Noninvasive Biomarkers for Nonalcoholic Fatty Liver Disease
Gîlcă-Blanariu, G.-E., Budur, D. S., Mitrică, D., Gologan, E., Timofte, O., Bălan, G. G., OLTEANU, V.-A., & Ștefănescu, G. (2023) · Metabolites · doi:10.3390/metabo13111115 · Cited by 21 · see citing works
“The risk of developing a hepatocellular carcinoma from NAFLD can be assessed using the Polygenic Risk Score-5, which combines PNPLA3, TM6SF2, GCKR, and MBOAT7 [184].”
Background
Effectiveness of Six International Guidelines Using Fibrosis-4 and FibroScan for Risk Stratification of Metabolic Dysfunction-associated Steatotic Liver Disease in Type 2 Diabetes
Vidal-Trécan, T., Julla, J., Khoury, T. E., Venteclef, N., Riveline, J., Paradis, V., Valla, D. C., Gautier, J., & Castéra, L. (2025) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2025.02.018 · Cited by 20 · see citing works
Liver stiffness as a dynamic predictor of decompensation and mortality in alcohol-related liver disease
Addissouky, T. A. (2024) · Discover Medicine · doi:10.1007/s44337-024-00083-x · Cited by 16 · see citing works
HTD1801 demonstrates promising potential for histologic improvements in metabolic dysfunction-associated steatohepatitis in both a preclinical and phase 2 study
Wong, V. W., Neff, G. W., Bisceglie, A. M. D., Bai, R., Cheng, J., Meng, Y., Liberman, A., Liu, L., & Gunn, N. (2025) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2025.0145 · Cited by 15 · see citing works
Personalized Risk Assessment of Hepatic Fibrosis after Cholecystectomy in Metabolic-Associated Steatotic Liver Disease: A Machine Learning Approach
Suárez, M., Martínez, R., Torres, A., Ramón, A., Blasco, P., & Mateo, J. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12206489 · Cited by 15 · see citing works
Noninvasive assessment of liver fibrosis and portal hypertension
Duarte‐Rojo, A., Patel, K., & Rockey, D. C. (2024) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000001019 · Cited by 16 · see citing works
The biochemical pattern defines MASLD phenotypes linked to distinct histology and prognosis
Ampuero, J., Aller, R., Gallego‐Durán, R., Crespo, J., Calleja, J. L., García‐Monzón, C., Gómez‐Camarero, J., Caballería, J., Iacono, O. L., Ibáñez, L., et al. (2024) · Journal of Gastroenterology · doi:10.1007/s00535-024-02098-8 · Cited by 17 · see citing works
A Pragmatic Management Approach for Metabolic Dysfunction-Associated Steatosis and Steatohepatitis
Shah, N., & Sanyal, A. J. (2024) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003215 · Cited by 15 · see citing works
Exploring Opportunities to Enhance the Screening and Surveillance of Hepatocellular Carcinoma in Non-Alcoholic Fatty Liver Disease (NAFLD) through Risk Stratification Algorithms Incorporating Ultrasound Elastography
Țâru, M.-G., & Lupșor‐Platon, M. (2023) · Cancers · doi:10.3390/cancers15164097 · Cited by 13 · see citing works
Meta‐analysis: Efficacy and safety of fibroblast growth factor 21 analogues for the treatment of non‐alcoholic steatohepatitis and non‐alcoholic steatohepatitis‐related fibrosis
Lin, R., Zhou, J., Sun, Q., Xin, X., Hu, Y., Zheng, M., & Feng, Q. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17889 · Cited by 12 · see citing works
Fibrosis status, extrahepatic multimorbidity and all-cause mortality in 53,093 women and 74,377 men with metabolic dysfunction associated steatotic liver disease (MASLD) in UK biobank
Feng, Q., Izzi‐Engbeaya, C. N., Manousou, P., & Woodward, M. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-04079-4 · Cited by 12 · see citing works
“Consequently, various non-invasive assessments have been developed and adopted in international guidelines for MASLD management [7, 8].”
Insulin-like Growth Factor Binding Proteins and Cellular Senescence Are Involved in the Progression of Non-Alcoholic Fatty Liver Disease and Fibrosis in a Mouse Model
Guzmán, C., Bautista-Ubaldo, M. G., Campos-Espinosa, A., Romero-Bello, I. I., Vargas, Á. D. S., & Gutiérrez‐Reyes, G. (2024) · Medicina · doi:10.3390/medicina60030429 · Cited by 12 · see citing works
“Non-alcoholic fatty liver disease (NAFLD) is the most prevalent hepatic disease world-wide, and it is highly associated with metabolic disorders, including obesity, insulin resistance, diabetes, and metabolic syndrome [1–3].”
GLP-1RAs regulate lipid metabolism and induce autophagy through AMPK/SIRT1 pathway to improve NAFLD
Zhang, Q., Wang, J., Hu, X., Lu, W., Cao, Y., Niu, C.-Y., & Yue, H. (2025) · Prostaglandins & Other Lipid Mediators · doi:10.1016/j.prostaglandins.2025.106987 · Cited by 11 · see citing works
The importance of patient engagement in the multimodal treatment of MASLD
Boeckmans, J., Hagström, H., Cryer, D. R. H., & Schattenberg, J. M. (2025) · Communications Medicine · doi:10.1038/s43856-025-00871-1 · Cited by 14 · see citing works
Performance of continuous controlled attenuation parameter and liver stiffness measurement by the novel SmartExam in metabolic dysfunction‐associated steatotic liver disease
Song, S. J., Nogami, A., Liang, L. Y., Yoneda, M., Leung, H. H. W., Nakajima, A., Lai, J. C., Wong, G. L., Shu, S. S., Wong, V. W., et al. (2024) · Liver International · doi:10.1111/liv.15862 · Cited by 11 · see citing works
The new definition of metabolic dysfunction-associated steatotic liver disease: the role of ultrasound and elastography
Jin, X., Yip, T. C., Wong, G. L., Wong, V. W., & Lai, J. C. (2025) · ULTRASONOGRAPHY · doi:10.14366/usg.24219 · Cited by 10 · see citing works
From NAFLD to MASLD: transforming steatotic liver disease diagnosis and management
Iruzubieta, P., Jiménez-González, C., Cabezas, J., & Crespo, J. (2025) · Metabolism and Target Organ Damage · doi:10.20517/mtod.2024.143 · Cited by 9 · see citing works
Research and application of medicines for treating liver fibrosis: current status and prospects
Chen, S., Wu, Z., Zhang, J., Lin, Y., Xie, J., Yin, D., & Zhu, Y. H. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1582258 · Cited by 10 · see citing works
Non-invasive tests for MetALD and alcohol-related liver disease
Johansen, S., Thiele, M. S., & Krag, A. A. (2025) · JHEP Reports · doi:10.1016/j.jhepr.2025.101569 · Cited by 10 · see citing works
“20,21 In this review, we examine current knowledge on the use of NITs for the diagnosis and prognostication of ALD and Met-ALD, as well as emerging data on tools for monitoring disease progression.”
The transition from NAFLD to MASLD: implications for Diagnosis, Prognosis, and Clinical Management
Acierno, C., Nevola, R., Barletta, F., Zielińska, K., Rinaldi, L., Sasso, F. C., Conte, C., Adinolfi, L. E., & Caturano, A. (2025) · Exploration of Medicine · doi:10.37349/emed.2025.1001365 · Cited by 11 · see citing works
Personalized MASLD and liver fibrosis risk assessment for adults: glycemic status determines optimal choice of non-invasive indices
Zhao, Y., Hu, D., Cheng, J., Cao, H., Wang, X., He, J., Zhu, Y., & Li, J. (2025) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-025-02069-w · Cited by 9 · see citing works
Association between menopause, body composition, and nonalcoholic fatty liver disease: A prospective cohort in northern China
Yang, C., Chen, S., Feng, B., Lu, Y., Wang, Y., Liao, W., Wu, S., & Wang, L. (2024) · Maturitas · doi:10.1016/j.maturitas.2024.108148 · Cited by 8 · see citing works
Pathological Evolution and Internal Medicine Management of Nonalcoholic Fatty Liver Disease (NAFLD) in the Era of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Hashim, M. M. A., Khan, M. A. M., Ashraf, M. U., Mohsin, S., Zahoor, K., Niazi, J., Khan, A., Muzaffar, S., Makhdumi, M., Ibad, O. A., et al. (2025) · Cureus · doi:10.7759/cureus.86963 · Cited by 8 · see citing works
Prognostic value of ALBI score for all-cause mortality in metabolic associated fatty liver disease patients: a cohort study from NHANES 2003–2018
Zhou, G., Han, W., Luan, J., & Ma, B. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-04117-1 · Cited by 8 · see citing works
“…paradigms confront dual limitations: reliance on imperfect diagnostic modalities (ultrasound, MRI, or biopsy) with inherent sensitivity constraints [8, 9], therapeutic options are currently limited to lifestyle interventions, as no approved disease-modifying pharmacologic agents exist [10, 11].”
Embracing Change: From Nonalcoholic Fatty Liver Disease to Metabolic Dysfunction-Associated Steatotic Liver Disease Under the Steatotic Liver Disease Umbrella
Noureddin, M., Wei, L., Castéra, L., & Tsochatzis, E. A. (2023) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2023.09.034 · Cited by 8 · see citing works
“One of the most intriguing developments arising from this renaming process is the recognition of the impact of moderate alcohol consumption on the natural history and response to therapies in NAFLD/MASLD.”
Noninvasive tools for the assessment of fibrosis in metabolic dysfunction-associated steatotic liver disease
Rigor, J., MARTINS, M. E., Passos, B., Oliveira, R., & Martins‐Mendes, D. (2024) · Minerva Medica · doi:10.23736/s0026-4806.24.09290-5 · Cited by 7 · see citing works
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Authors: Sanyal, A. J., Castera, L., & Wong, V. W.-S.
Affiliations: Virginia Commonwealth University (US)
Chinese University of Hong Kong (HK)
Corresponding author: Sanyal, Arun J.
Wong, Vincent Wai-Sun
ORCID: Sanyal, Arun J.
Castera, Laurent
Wong, Vincent Wai-Sun
Venue: Clinical Gastroenterology and Hepatology
Publisher: Elsevier BV
Published: 2023-07
Volume: 21
Issue: 8
Pages: 2026-2039
ISSN: 1542-3565 (ISSN-L)
DOI: 10.1016/j.cgh.2023.03.042
OpenAlex: W4365505095
Cited by: 157
References: 79
Citations by year: 2026: 39 · 2025: 57 · 2024: 49 · 2023: 12
FWCI: 6.11
Type: journal article
Language: en
Update notices: erratum (2024-03-01)
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 356 d)
Locations: Clinical Gastroenterology and Hepatology (acceptedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Keywords: non-alcoholic fatty liver disease, liver fibrosis, noninvasive fibrosis assessment, liver stiffness, elastography, serum biomarkers, liver biopsy limitations, liver cirrhosis, risk stratification, drug development, hepatocellular carcinoma risk
MeSH terms: Biopsy, Fibrosis, Humans, Liver Cirrhosis, Liver Neoplasms, Ultrasonography, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease

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Noninvasive assessment of liver fibrosis in NAFLD

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