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NAFLD and clinical significance of grading fibrosis

NAFLD is associated with increased risk of CVD and liver related clinical events. Hence, it is important to do risk categorization of NAFLD patients. It is the fibrosis in liver which is directly related to major adverse liver events (like cirrhosis, decompensated liver failure, hepatocellular carcinoma, liver transplantation and mortality). Hence, risk categorization has to be done based on grading of fibrosis (F0 to F4). F0 and F1 fibrosis is considered as no or minimal fibrosis and in such NAFLD patients, the risk of liver related event is not high compared to general population. Such F0 to F1 NAFLD patients should be managed for CV risk factors like controlling insulin resistance, diabetes, dyslipidemia (high TG and low HDL), blood pressure, body weight etc. F2 fibrosis category is considered as clinically significant fibrosis and there is increased risk of liver events and mortality. F3 is considered as an advanced fibrosis while F4 is considered as Cirrhosis. The gold standard method to grade the fibrosis in liver is biopsy, however, it has its limitation and disadvantages. Non invasive techniques, like biomarkers or non-invasive imaging technology can be useful tool to risk categorize NAFLD patients. FIB-4 scoring is a calculator based on age, AST, ALT and platelet, it is simple biomarker based test. Vibration controlled transient elastography (VCTE) is a non-invasive simple imaging technique which can also be used for grading the liver stiffness (fibrosis).