SOURCE: Bazick J, et al. Clinical model for NASH and advanced fibrosis in adult patients with diabetes and NAFLD: Guidelines for referral in NAFLD. Diabetes Care 2015;38:1347-1355.

The language of progressive steps in liver disease used to be simpler: You had cirrhosis, or you didn’t.

But things have gotten much more complicated. Non-alcoholic fatty liver disease (NAFLD) is now reported to be the most common cause of chronic liver disease in the United States, and is present in 50-75% of diabetics, thus representing as many as 18 million people among diabetics alone.

Were NAFLD to simply stay NAFLD, we would have much less to discuss. Unfortunately, 10-22% of NAFLD patients have a progressive type called non-alcoholic steatohepatitis (NASH), which itself may progress to cirrhosis and hepatocellular carcinoma.

One way to identify NAFLD patients with NASH is to perform liver biopsy; appraisal of the degree and pattern of fibrosis seen on liver biopsy provides grounds for staging of NASH. But since there is risk, expense, and discomfort associated with this procedure, identification of other biologic markers indicative of NASH has been sought.

Bazick et al reported on the development of a panel of markers that have suitable sensitivity and specificity to identify which patients with NAFLD are most likely to have NASH, potentially benefitting from referral for liver biopsy and confirmation of degree of fibrosis. The panel includes age, ethnicity, body mass index, waist:hip ratio, liver function tests, international normalized ratio, serum proteins, complete blood count, and serum insulin levels, all of which are obtainable with minimum of patient inconvenience.