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BackgroundClinical trials enroll patients with active fibrotic nonalcoholic steatohepatitis (NASH) (nonalcoholic fatty liver disease [NAFLD] activity score ≥ 4) and significant fibrosis (F ≥ 2); however, screening failure rates are high following biopsy. We developed new scores to identify active fibrotic NASH using FibroScan and magnetic resonance imaging (MRI).MethodsWe undertook prospective primary (n = 176), retrospective validation (n = 169), and University of California San Diego (UCSD; n = 234) studies of liver biopsy-proven NAFLD. Liver stiffness measurement (LSM) using FibroScan or magnetic resonance elastography (MRE), controlled attenuation parameter (CAP), or proton density fat fraction (PDFF), and aspartate aminotransferase (AST) were combined to develop a two-step strategy-FibroScan-based LSM followed by CAP with AST (F-CAST) and MRE-based LSM followed by PDFF with AST (M-PAST)-and compared with FibroScan-AST (FAST) and MRI-AST (MAST) for diagnosing active fibrotic NASH. Each model was categorized using rule-in and rule-out criteria.ResultsAreas under receiver operating characteristic curves (AUROCs) of F-CAST (0.826) and M-PAST (0.832) were significantly higher than those of FAST (0.744, p = 0.004) and MAST (0.710, p

Aims Methods Results Conclusions The multisociety consensus nomenclature has introduced steatotic liver disease (SLD) with diverse subclassifications, which are metabolic dysfunction‐associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol‐associated steatotic liver disease (MetALD), alcohol‐associated liver disease (ALD), specific etiology, and cryptogenic. We investigated their prevalence, as per the new definition, in individuals undergoing health check‐ups. Additionally, we analyzed the distribution of Fibrosis‐4 (FIB‐4) index and vibration‐controlled transient elastography (VCTE)‐derived liver stiffness measurement (LSM) for MASLD.In this cross‐sectional study, 6530 subjects undergoing a health check‐up in Japan were included. Conventional B‐mode ultrasound was carried out on all 6530 subjects, and those with MASLD underwent VCTE.The prevalence of SLD was 39.5%, comprising MASLD 28.7%, MetALD 8.6%, ALD 1.2%, specific etiology SLD 0.3%, and cryptogenic SLD 0.7%. Subjects with VCTE‐derived LSM ≥8 kPa constituted 2.1% of MASLD. FIB‐4 ≥1.3 showed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value for diagnosing VCTE‐derived LSM ≥8 kPa were 60.6%, 77.0%, 5.3%, and 98.9%, respectively. The referral rate to specialists was 23.8% using FIB‐4 ≥1.30. “FIB‐4 ≥1.3 in subjects <65 years and FIB‐4 ≥2.0 in subjects ≥65 years” showed higher PPV (6.7%) and lower referral rate (17.1%) compared with FIB‐4 ≥1.3, but the sensitivity (54.5%) did not show adequate diagnostic capability as a noninvasive test for diagnosing VCTE‐derived LSM ≥8 kPa.Acknowledging the selection bias in hepatology centers, we undertook this prospective health check‐up study. Although the FIB‐4 index proves to be a convenient marker, it might not perform well as a primary screening tool for liver fibrosis in the general population (UMIN Clinical Trials Registry No. UMIN000035188). [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the diagnostic accuracy of the measurement of serum type IV collagen 7S (T4C7S) concentration for the staging of liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods: A systematic search or published works was carried out using the PubMed, Cochrane Library, and Web of Science Core Collection databases for studies of the accuracy of serum T4C7S concentration for the staging of fibrosis using Fibrosis stage (F)0–4 in patients with NAFLD diagnosed by liver biopsy. Results: Nine articles describing 1475 participants with NAFLD were included. For fibrosis ≥F1, with n = 849, summary estimates of sensitivity of 0.79, specificity of 0.69, and area under the curve (AUC) of 0.80 were obtained using a median T7C4S cut‐off value of 4.6 ng/ml. For fibrosis ≥F2, with n = 1,090, summary estimates of sensitivity of 0.78, specificity of 0.78, and AUC of 0.84 were obtained using a median cut‐off value of 4.9 ng/ml. For fibrosis ≥F3, with n = 1311 participants and a median cut‐off value of 5.4 ng/ml, a pooled sensitivity of 0.82, specificity of 0.81, and AUC of 0.83 were obtained. For fibrosis ≥F4, with n = 753 and a median cut‐off value of 6.6 ng/ml, a pooled sensitivity of 0.85, specificity of 0.81, and AUC of 0.85 were obtained. Conclusions: Serum T4C7S concentration was found to be an accurate method of staging liver fibrosis in patients with NAFLD. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions The prevalence of metabolic dysfunction‐associated steatotic liver disease (MASLD), including its severe subtype, metabolic dysfunction‐associated steatohepatitis (MASH), is increasing worldwide. This condition is a major health concern as MASH can progress to cirrhosis and hepatocellular carcinoma. With no specific medications available, lifestyle modifications, particularly dietary and exercise interventions, are crucial for managing MASLD. This study aimed to analyze the color characteristics of meals consumed by MASLD patients, seeking insights for dietary modifications.We quantitatively analyzed the chromaticity, hue, and chroma of photographs of patients' meals and compared these statistical measures with those of nutritionally balanced meals recommended by dietitians. We also examined associations between the color characteristics of patients' meals, their clinical data, and dietary nutrients.Patients' meals exhibited significantly lower variances in chromaticity (a∗ and b∗) and lower average chroma compared to nutritionally balanced meals. Specifically, the overall mean of variance of a∗ for patients' meals was 151.1, compared to 340.5 for nutritionally balanced meals. The overall mean of average chroma for patients' meals was 24.54, whereas that for nutritionally balanced meals was 34.47. Additionally, patients' dietary patterns were found to be potentially linked not only to nutritional deficiencies but also to the prognosis and progression of hepatic fibrosis and MASLD severity.This study reveals reduced color vibrancy and diversity in the diets of MASLD patients, suggesting potential dietary modifications to improve nutritional habits and clinical management for MASLD patients. [ABSTRACT FROM AUTHOR]