TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease and is significantly associated with obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. NAFLD has become the most prevalent chronic liver disease in Western countries, and the proportion of NAFLD-related cirrhosis among patients on liver transplantation waiting lists has increased. In light of the accumulated data about NAFLD, and to provide a common approach with multi-disciplines dealing with the subject, it has become necessary to create new guidance for diagnosing and treating NAFLD. This guidance was prepared following an interdisciplinary study under the leadership of the Turkish Association for the Study of the Liver (TASL), Fatty Liver Special Interest Group. This new TASL Guidance is a practical application guide on NAFLD and was prepared to standardize the clinical approach to diagnosing and treating NAFLD patients. This guidance reflects many advances in the field of NAFLD. The proposals in this guidance are meant to aid decision-making in clinical practice. The guidance is primarily intended for gastroenterology, endocrinology, metabolism diseases, cardiology, internal medicine, pediatric specialists, and family medicine specialists.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73-84.
2. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018;67:328-357.
3. European Association for the Study of the L, European Association for the Study of D, European Association for the Study of O. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016;64:1388-1402.
4. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012;142:1592-1609.
5. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol 2020;73:202-209.
6. Eslam M, Sanyal AJ, George J, International Consensus P. MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology 2020;158:1999-2014 e1991.
7. Demirtaş CO, Yilmaz Y. Metabolic-associated Fatty Liver Disease: Time to integrate ground-breaking new terminology to our clinical practice? Hepatology Forum 2020;3:79-81.
8. Yilmaz Y, Byrne CD, Musso G. A single-letter change in an acronym: signals, reasons, promises, challenges, and steps ahead for moving from NAFLD to MAFLD. Expert Rev Gastroenterol Hepatol 2021;4:345-352.
9. Younossi Z, Tacke F, Arrese M, Chander Sharma B, Mostafa I, Bugianesi E, et al. Global Perspectives on Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Hepatology 2019;69:2672-2682.
10. Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic Steatohepatitis: A Review. JAMA 2020;323:1175-1183.
11. Yilmaz Y, Yilmaz N, Ates F, Karakaya F, Gokcan H, Kaya E, et al. The prevalence of metabolic associated fatty liver disease in the Turkish population: A multicenter study. Hepatology Forum 2021;2:37-42.
12. Marchesini G, Mazzotti A. NAFLD incidence and remission: only a matter of weight gain and weight loss? J Hepatol 2015;62:15-17.
13. Satman I KS, Salman S, Sengul A, Sargin M, Karsidag K, Dinccag N, et al. Defining a population-specific waist circumference in Turkish population In: 89th Annual Meeting ENDO 07, June 2-5, 2007, Toronto, Canada; 2007.
14. Dinccag N SI, Kalaca S, Omer B, Karsidag K, Yilmaz T, Tutuncu Y, et al, the TURDEP-II Study Group. T. The prevalence of the metabolic syndrome is comparable using the nation-specific IDF, WHO and NECPATP III criteria in Turkey. In: 47th EASD Annual Meeting. Lisbon, Portugal Diabetologia Diabetologia 2011. p. 2544.
15. Kaya E, Yilmaz Y. Türkiye’de ve dünyada nonalkolik yağlı karaciğer hastalığı epidemiyolojisi. Sonsuz A, editör. Nonalkolik Yağlı Karaciğer Hastalığı,1. Baskı. Ankara: Türkiye Klinikleri, 2019; p 1-7.
16. Sheth SG CS. Epidemiology, clinical features, and diagnosis of nonalcoholic fatty liver disease in adults. In. UpToDate, Post TW (Ed): UpToDate, Waltham, MA. 2020.
17. Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 2001;21:17-26.
18. Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol 2008;49:608-612.
19. Soderberg C, Stal P, Askling J, Glaumann H, Lindberg G, Marmur J, et al. Decreased survival of subjects with elevated liver function tests during a 28-year follow-up. Hepatology 2010;51:595-602.
20. Targher G, Byrne CD, Tilg H. NAFLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications. Gut 2020;69:1691-1705.
21. Lazo M, Hernaez R, Bonekamp S, Kamel IR, Brancati FL, Guallar E, et al. Nonalcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ 2011;343:d6891.
22. Younossi Z, Henry L. Contribution of Alcoholic and Nonalcoholic Fatty Liver Disease to the Burden of Liver-Related Morbidity and Mortality. Gastroenterology 2016;150:1778-1785.
23. Dulai PS, Singh S, Patel J, Soni M, Prokop LJ, Younossi Z, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis. Hepatology 2017;65:1557-1565.
24. Vilar-Gomez E, Calzadilla-Bertot L, Wai-Sun Wong V, Castellanos M, Aller-de la Fuente R, Metwally M, et al. Fibrosis Severity as a Determinant of CauseSpecific Mortality in Patients With Advanced Nonalcoholic Fatty Liver Disease: A Multi-National Cohort Study. Gastroenterology 2018;155:443-457 e417.
25. Castera L. Non-invasive tests for liver fibrosis in NAFLD: Creating pathways between primary healtcare and liver clinics. Liver Intern 2020;S1:77-81.
26. Tovo CV, Villela-Nogueira CA, Leite NC, Panke CL, Port GZ, Fernandes S, et al. Transient hepatic elastography has the best performance to evaluate liver fibrosis in non-alcoholic fatty liver disease (NAFLD). Ann Hepatol 2019;18:445-449.
27. Mustapic S, Ziga S, Matic V, Bokun T, Radic B, Lucijanic M, et al. Ultrasound Grade of Liver Steatosis Is Independently Associated with the Risk of Metabolic Syndrome. Can J Gastroenterol Hepatol 2018;2018:8490242.
28. Reddy YK, Marella HK, Jiang Y, Ganguli S, Snell P, Podila PSB et al. Natural history of non-alcoholic fatty liver disease: A study with paired liver biopsies. J Clin Exp Hepatol 2020;10:245-54.
29. Sanyal AJ, Harrison SA, Ratziu V, Abdelmalek MF, Diehl AM, Caldwell S, et al. The Natural History of Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: Data From the Simtuzumab Trials. Hepatology 2019;70:1913-1927.
30. Pais R, Charlotte F, Fedchuk L, Bedossa P, Lebray P, Poynard T, et al. A systematic review of follow-up biopsies reveals disease progression in patients with non-alcoholic fatty liver. J Hepatol 2013;59:550-556.
31. Dam-Larsen S, Franzmann M, Andersen IB, Christoffersen P, Jensen LB, Sorensen TI, et al. Long term prognosis of fatty liver: risk of chronic liver disease and death. Gut 2004;53:750-755.
32. Valenti L, Dongiovanni P, Fargion S. Diagnostic and therapeutic implications of the association between ferritin level and severity of nonalcoholic fatty liver disease. World J Gastroenterol 2012;18:3782-3786.
33. Dongiovanni P, Donati B, Fares R, Lombardi R, Mancina RM, Romeo S, et al. PNPLA3 I148M polymorphism and progressive liver disease. World J Gastroenterol 2013;19:6969-6978.
34. Severson TJ, Besur S, Bonkovsky HL. Genetic factors that affect nonalcoholic fatty liver disease: A systematic clinical review. World J Gastroenterol 2016;22:6742-6756.
35. Jarvis H, Craig D, Barker R, Spiers G, Stow D, Anstee QM, et al. Metabolic risk factors and incident advanced liver disease in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of population-based observational studies. PLoS Med 2020;17:e1003100.
36. Younossi ZM, Golabi P, de Avila L, Paik JM, Srishord M, Fukui N, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol 2019;71:793-801.
37. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol 2015;62:S47-64.
38. Tsochatzis E, Coilly A, Nadalin S, Levistky J, Tokat Y, Ghobrial M, et al. International Liver Transplantation Consensus Statement on End-stage Liver Disease Due to Nonalcoholic Steatohepatitis and Liver Transplantation. Transplantation 2019;103:45-56.
39. Alswat KA, Fallatah HI, Al-Judaibi B, Elsiesy HA, Al-Hamoudi WK, Qutub AN, et al. Position statement on the diagnosis and management of non-alcoholic fatty liver disease. Saudi Med J 2019;40:531-540.
40. Wong VW, Chan WK, Chitturi S, Chawla Y, Dan YY, Duseja A, et al. Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 1: Definition, risk factors and assessment. J Gastroenterol Hepatol 2018;33:70-85.
41. Jegatheesan P, De Bandt JP. Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism. Nutrients 2017;9.
42. Yilmaz Y. Review article: fructose in non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2012;35:1135-1144.
43. Williams R, Alexander G, Armstrong I, Baker A, Bhala N, Camps-Walsh G, et al. Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet 2018;391:1097-1107.
44. Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology 2005;42:44-52.
45. Lai LL, Wan Yusoff WNI, Vethakkan SR, Nik Mustapha NR, Mahadeva S, Chan WK. Screening for non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography. J Gastroenterol Hepatol 2019;34:1396-1403.
46. Ma J, Hwang SJ, Pedley A, Massaro JM, Hoffmann U, Chung RT, et al. Bi-directional analysis between fatty liver and cardiovascular disease risk factors. J Hepatol 2017;66:390-397.
47. Oni ET, Agatston AS, Blaha MJ, Fialkow J, Cury R, Sposito A, et al. A systematic review: burden and severity of subclinical cardiovascular disease among those with nonalcoholic fatty liver; should we care? Atherosclerosis 2013;230:258-267.
48. Velarde-Ruiz Velasco JA, Garcia-Jimenez ES, Garcia-Zermeno KR, MorelCerda EC, Aldana-Ledesma JM, Castro-Narro GE, et al. Extrahepatic complications of non-alcoholic fatty liver disease: Its impact beyond the liver. Rev Gastroenterol Mex 2019;84:472-481.
49. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of noninvasive tests for liver disease severity. Ann Med 2011;43:617-649.
50. Whitsett M, Wilcox J, Yang A, Zhao L, Rinella M, VanWagner LB. Atrial fibrillation is highly prevalent yet undertreated in patients with biopsy-proven nonalcoholic steatohepatitis. Liver Int 2019;39:933-940.
51. VanWagner LB, Wilcox JE, Ning H, Lewis CE, Carr JJ, Rinella ME, et al. Longitudinal Association of Non-Alcoholic Fatty Liver Disease With Changes in Myocardial Structure and Function: The CARDIA Study. J Am Heart Assoc 2020;9:e014279.
52. Markus MR, Baumeister SE, Stritzke J, Dorr M, Wallaschofski H, Volzke H, et al. Hepatic steatosis is associated with aortic valve sclerosis in the general population: the Study of Health in Pomerania (SHIP). Arterioscler Thromb Vasc Biol 2013;33:1690-1695.
53. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Rev Esp Cardiol (Engl Ed) 2016;69:939.
54. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41:111-188.
55. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;74:1376-1414.
56. Golabi P, Fukui N, Paik J, Sayiner M, Mishra A, Younossi ZM. Mortality Risk Detected by Atherosclerotic Cardiovascular Disease Score in Patients With Nonalcoholic Fatty Liver Disease. Hepatol Commun 2019;3:1050-1060.
57. Pisetta C, Chille C, Pelizzari G, Pigozzi MG, Salvetti M, Paini A, et al. Evaluation of Cardiovascular Risk in Patient with Primary Non-alcoholic Fatty Liver Disease. High Blood Press Cardiovasc Prev 2020;27:321-330.
58. Athyros VG, Giouleme O, Ganotakis ES, Elisaf M, Tziomalos K, Vassiliadis T, et al. Safety and impact on cardiovascular events of long-term multifactorial treatment in patients with metabolic syndrome and abnormal liver function tests: a post hoc analysis of the randomised ATTEMPT study. Arch Med Sci 2011;7:796-805.
59. Athyros VG, Tziomalos K, Gossios TD, Griva T, Anagnostis P, Kargiotis K, et al. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Lancet 2010;376:1916-1922.
60. Zheng SL, Roddick AJ. Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Metaanalysis. JAMA 2019;321:277-287
61. VanWagner LB, Wilcox JE, Colangelo LA, Lloyd-Jones DM, Carr JJ, Lima JA, et al. Association of nonalcoholic fatty liver disease with subclinical myocardial remodeling and dysfunction: A population-based study. Hepatology 2015;62:773-783.
62. Targher G, Chonchol MB, Byrne CD. CKD and nonalcoholic fatty liver disease. Am J Kidney Dis 2014;64:638-652.
63. Targher G, Byrne CD. Non-alcoholic fatty liver disease: an emerging driving force in chronic kidney disease. Nat Rev Nephrol 2017;13:297-310.
64. Arase Y, Suzuki F, Kobayashi M, Suzuki Y, Kawamura Y, Matsumoto N, et al. The development of chronic kidney disease in Japanese patients with non-alcoholic fatty liver disease. Intern Med 2011;50:1081-1087.
65. Yasui K, Sumida Y, Mori Y, Mitsuyoshi H, Minami M, Itoh Y, et al. Nonalcoholic steatohepatitis and increased risk of chronic kidney disease. Metabolism 2011;60:735-739.
66. Targher G, Bertolini L, Rodella S, Lippi G, Zoppini G, Chonchol M. Relationship between kidney function and liver histology in subjects with nonalcoholic steatohepatitis. Clin J Am Soc Nephrol 2010;5:2166-2171.
67. Kiapidou S, Liava C, Kalogirou M, Akriviadis E, Sinakos E. Chronic kidney disease in patients with non-alcoholic fatty liver disease: What the Hepatologist should know? Ann Hepatol 2020;19:134-144.
68. National Kidney F. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1- 266.
69. Levin A, Stevens PE. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int 2014;85:49-61.
70. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-612.
71. Murphree DD, Thelen SM. Chronic kidney disease in primary care. J Am Board Fam Med 2010;23:542-550.
72. Yilmaz Y, Alahdab YO, Yonal O, Kurt R, Kedrah AE, Celikel CA, et al. Microalbuminuria in nondiabetic patients with nonalcoholic fatty liver disease: association with liver fibrosis. Metabolism 2010;59:1327-1330.
73. Musso G, Gambino R, Tabibian JH, Ekstedt M, Kechagias S, Hamaguchi M, et al. Association of non-alcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS Med 2014;11:e1001680.
74. Mantovani A, Petracca G, Beatrice G, Csermely A, Lonardo A, Schattenberg JM, et al. Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: an updated meta-analysis. Gut 2020.
75. Ye Q, Zou B, Yeo YH, Li J, Huang DQ, Wu Y, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5:739- 752.
76. Yilmaz Y, Kani HT, Demirtas CO, Kaya E, Sapmaz AF, Qutranji L, et al. Growing burden of nonalcoholic fatty liver disease in Turkey: A single-center experience. Turk J Gastroenterol 2019;30:892-898.
77. Akyuz U, Yesil A, Yilmaz Y. Characterization of lean patients with nonalcoholic fatty liver disease: potential role of high hemoglobin levels. Scand J Gastroenterol 2015;50:341-346.
78. Uslusoy HS, Nak SG, Gulten M. Noninvasive predictors for liver fibrosis in patients with nonalcoholic steatohepatitis. World J Hepatol 2011;3:219-227.
79. Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Arch Intern Med 2008;168:1617-1624.
80. Karelis AD, St-Pierre DH, Conus F, Rabasa-Lhoret R, Poehlman ET. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab 2004;89:2569-2575.
81. Ruderman N, Chisholm D, Pi-Sunyer X, Schneider S. The metabolically obese, normal-weight individual revisited. Diabetes 1998;47:699-713.
82. Younossi ZM, Stepanova M, Negro F, Hallaji S, Younossi Y, Lam B, et al.Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore) 2012;91:319-327.
83. Wei JL, Leung JC, Loong TC, Wong GL, Yeung DK, Chan RS, et al. Prevalence and Severity of Nonalcoholic Fatty Liver Disease in Non-Obese Patients: A Population Study Using Proton-Magnetic Resonance Spectroscopy. Am J Gastroenterol 2015;110:1306-1314; quiz 1315.
84. Hu X, Huang Y, Bao Z, Wang Y, Shi D, Liu F, et al. Prevalence and factors associated with nonalcoholic fatty liver disease in Shanghai work-units. BMC Gastroenterol 2012;12:123.
85. Chan WK, Treeprasertsuk S, Imajo K, Nakajima A, Seki Y, Kasama K, et al. Clinical features and treatment of nonalcoholic fatty liver disease across the Asia Pacific region-the GO ASIA initiative. Aliment Pharmacol Ther 2018;47:816- 825.
86. Albhaisi S, Chowdhury A, Sanyal AJ. Non-alcoholic fatty liver disease in lean individuals. JHEP Rep 2019;1:329-341.
87. Duarte SMB, Stefano JT, Miele L, Ponziani FR, Souza-Basqueira M, Okada L, et al. Gut microbiome composition in lean patients with NASH is associated with liver damage independent of caloric intake: A prospective pilot study. Nutr Metab Cardiovasc Dis 2018;28:369-384.
88. Yun Y, Kim HN, Lee EJ, Ryu S, Chang Y, Shin H, et al. Fecal and blood microbiota profiles and presence of nonalcoholic fatty liver disease in obese versus lean subjects. PLoS One 2019;14:e0213692.
89. Feldman A, Eder SK, Felder TK, Kedenko L, Paulweber B, Stadlmayr A, et al. Clinical and Metabolic Characterization of Lean Caucasian Subjects With Nonalcoholic Fatty Liver. Am J Gastroenterol 2017;112:102-110.
90. Li C, Guo P, Okekunle AP, Ji X, Huang M, Qi J, et al. Lean non-alcoholic fatty liver disease patients had comparable total caloric, carbohydrate, protein, fat, iron, sleep duration and overtime work as obese non-alcoholic fatty liver disease patients. J Gastroenterol Hepatol 2019;34:256-262.
91. Sharp KPH, Schultz M, Coppell KJ. Is non-alcoholic fatty liver disease a reflection of what we eat or simply how much we eat? JGH Open 2018;2:59-74.
92. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37:917-923.
93. Margariti A, Deutsch M, Manolakopoulos S, Tiniakos D, Papatheodoridis GV. The severity of histologic liver lesions is independent of body mass index in patients with nonalcoholic fatty liver disease. J Clin Gastroenterol 2013;47:280- 286.
94. Dela Cruz A BE, George J, Bugianesi E, Day C, Liaquat H, Charatcharoenwitthaya P, et al. Characteristics and long-term prognosis of lean patients with nonalcoholic fatty liver disease. Gastroenterology 2014;146:S909.
95. Leung JC, Loong TC, Wei JL, Wong GL, Chan AW, Choi PC, et al. Histological severity and clinical outcomes of nonalcoholic fatty liver disease in nonobese patients. Hepatology 2017;65:54-64.
96. Sookoian S, Pirola CJ. Systematic review with meta-analysis: the significance of histological disease severity in lean patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther 2018;47:16-25.
97. Wang AY, Dhaliwal J, Mouzaki M. Lean non-alcoholic fatty liver disease. Clin Nutr 2019;38:975-981.
98. Bernhardt P, Kratzer W, Schmidberger J, Graeter T, Gruener B, EMIL Study Group. Laboratory parameters in lean NAFLD: comparison of subjects with lean NAFLD with obese subjects without hepatic steatosis. BMC Res Notes 2018;11:101.
99. Hagstrom H, Nasr P, Ekstedt M, Hammar U, Stal P, Hultcrantz R, et al. Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: A long-term follow-up study. Hepatol Commun 2018;2:48-57.
100. Weinberg EM, Trinh HN, Firpi RJ, Bhamidimarri KR, Klein S, Durlam J, et al. Lean Americans With Nonalcoholic Fatty Liver Disease Have Lower Rates of Cirrhosis and Co-morbid Diseases. Clin Gastroenterol Hepatol 2020.
101. Hirose S, Matsumoto K, Tatemichi M, Tsuruya K, Anzai K, Arase Y, et al. Nineteen-year prognosis in Japanese patients with biopsy-proven nonalcoholic fatty liver disease: Lean versus overweight patients. PLoS One 2020;15:e0241770.
102. Hamurcu Varol P, Kaya E, Alphan E, Yilmaz Y. Role of intensive dietary and lifestyle interventions in the treatment of lean nonalcoholic fatty liver disease patients. Eur J Gastroenterol Hepatol 2020;32:1352-1357.
103. Boyle M, Masson S, Anstee QM. The bidirectional impacts of alcohol consumption and the metabolic syndrome: Cofactors for progressive fatty liver disease. J Hepatol 2018;68:251-267.
104. Brunt EM, Ramrakhiani S, Cordes BG, Neuschwander-Tetri BA, Janney CG, Bacon BR, et al. Concurrence of histologic features of steatohepatitis with other forms of chronic liver disease. Mod Pathol 2003;16:49-56.
105. Choi HSJ, Brouwer WP, Zanjir WMR, de Man RA, Feld JJ, Hansen BE, et al. Nonalcoholic Steatohepatitis Is Associated With Liver-Related Outcomes and All-Cause Mortality in Chronic Hepatitis B. Hepatology 2020;71:539-548.
106. Chiang DJ, McCullough AJ. The impact of obesity and metabolic syndrome on alcoholic liver disease. Clin Liver Dis 2014;18:157-163.
107. Ceballos N, Babor TF. Editor’s Corner: Binge Drinking and the Evolving Language of Alcohol Research. J Stud Alcohol Drugs 2017;78:488-490.
108. Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect 2015;21:1020-1026.
109. Chan AW, Wong GL, Chan HY, Tong JH, Yu YH, Choi PC, et al. Concurrent fatty liver increases risk of hepatocellular carcinoma among patients with chronic hepatitis B. J Gastroenterol Hepatol 2017;32:667-676.
110. Li J, Yang HI, Yeh ML, Le MH, Le AK, Yeo YH, et al. Association between fatty liver and cirrhosis, hepatocellular carcinoma, and HBsAg seroclearance in chronic hepatitis B. J Infect Dis 2020.
111. Chan TT, Chan WK, Wong GL, Chan AW, Nik Mustapha NR, Chan SL, et al. Positive Hepatitis B Core Antibody Is Associated With Cirrhosis and Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease. Am J Gastroenterol 2020;115:867-875.
112. Ergenc I GP, Adali G, Kani HT, Ozer Demirtas C, Gunduz F, Ataizi Celikel C, et al. High incidence of hepatitis B core antibody positivity in metabolic-associated fatty liver disease-related cirrhosis. Hepatology Forum 2021;1:20-25.
113. Patton HM, Patel K, Behling C, Bylund D, Blatt LM, Vallee M, et al. The impact of steatosis on disease progression and early and sustained treatment response in chronic hepatitis C patients. J Hepatol 2004;40:484-490.
114. Pazienza V, Clement S, Pugnale P, Conzelman S, Foti M, Mangia A, et al.The hepatitis C virus core protein of genotypes 3a and 1b downregulates insulin receptor substrate 1 through genotype-specific mechanisms. Hepatology 2007;45:1164-1171.
115. Peleg N, Issachar A, Sneh Arbib O, Cohen-Naftaly M, Harif Y, Oxtrud E, et al. Liver steatosis is a major predictor of poor outcomes in chronic hepatitis C patients with sustained virological response. J Viral Hepat 2019;26:1257-1265.
116. Kwok R, Tse YK, Wong GLH, Ha Y, Lee AU, Ngu MC, et al. Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease--the role of transient elastography and plasma cytokeratin-18 fragments. Aliment Pharmacol Ther 2014;39:254-269.
117. Yilmaz Y. Systematic review: caspase-cleaved fragments of cytokeratin 18 - the promises and challenges of a biomarker for chronic liver disease. Aliment Pharmacol Ther 2009;30:1103-1109.
118. Ajmera V, Perito ER, Bass NM, Terrault NA, Yates KP, Gill R, et al. Novel plasma biomarkers associated with liver disease severity in adults with nonalcoholic fatty liver disease. Hepatology 2017;65:65-77.
119. Adler M, Gulbis B, Moreno C, Evrard S, Verset G, Golstein P, et al. The predictive value of FIB-4 versus FibroTest, APRI, FibroIndex and Forns index to noninvasively estimate fibrosis in hepatitis C and nonhepatitis C liver diseases. Hepatology 2008;47:762-763; author reply 763.
120. Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ, Nash Clinical Research N. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2009;7:1104- 1112.
121. McPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut 2010;59:1265-1269.
122. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45:846-854.
123. Xiao G, Zhu S, Xiao X, Yan L, Yang J, Wu G. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Hepatology 2017;66:1486-1501.
124. Kaya E, Bakir A, Eren F, Yilmaz Y. The utility of noninvasive scores in nonalcoholic fatty liver disease patients with normal and elevated serum transaminases. Hepatology Forum. 2020;1:8-13.
125. Alkayyali T, Qutranji L, Kaya E, Bakir A, Yilmaz Y. Clinical utility of noninvasive scores in assessing advanced hepatic fibrosis in patients with type 2 diabetes mellitus: a study in biopsy-proven non-alcoholic fatty liver disease. Acta Diabetol 2020;57:613-618.
126. Kaya E, Bakir A, Kani HT, Demirtas CO, Keklikkiran C, Yilmaz Y. Simple Noninvasive Scores Are Clinically Useful to Exclude, Not Predict, Advanced Fibrosis: A Study in Turkish Patients with Biopsy-Proven Nonalcoholic Fatty Liver Disease. Gut Liver 2020;14:486-491.
127. Guha IN, Parkes J, Roderick P, Chattopadhyay D, Cross R, Harris S, et al. Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: Validating the European Liver Fibrosis Panel and exploring simple markers. Hepatology 2008;47:455-460.
128. Daniels SJ, Leeming DJ, Eslam M, Hashem AM, Nielsen MJ, Krag A, et al. ADAPT: An Algorithm Incorporating PRO-C3 Accurately Identifies Patients With NAFLD and Advanced Fibrosis. Hepatology 2019;69:1075-1086.
129. Boyle M, Tiniakos D, Schattenberg JM, Ratziu V, Bugianessi E, Petta S, et al. Performance of the PRO-C3 collagen neo-epitope biomarker in non-alcoholic fatty liver disease. JHEP Rep 2019;1:188-198.
130. McPherson S, Hardy T, Dufour JF, Petta S, Romero-Gomez M, Allison M, et al. Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis. Am J Gastroenterol 2017;112:740-751.
131. Eren F, Kaya E, Yilmaz Y. Accuracy of Fibrosis-4 index and non-alcoholic fatty liver disease fibrosis scores in metabolic (dysfunction) associated fatty liver disease according to body mass index: failure in the prediction of advanced fibrosis in lean and morbidly obese individuals. Eur J Gastroenterol Hepatol 2022;34:98-103.
132. Yigit B, Boyle M, Ozler O, Erden N, Tutucu F, Hardy T, et al. Plasma cell-free DNA methylation: a liquid biomarker of hepatic fibrosis. Gut 2018;67:1907- 1908.
133. Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, et al.Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology 2011;54:1082-1090.
134. Yoneda M, Suzuki K, Kato S, Fujita K, Nozaki Y, Hosono K, et al. Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology 2010;256:640-647.
135. Cui J, Heba E, Hernandez C, Haufe W, Hooker J, Andre MP, et al. Magnetic resonance elastography is superior to acoustic radiation force impulse for the Diagnosis of fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease: A prospective study. Hepatology 2016;63:453-461.
136. Cassinotto C, Boursier J, de Ledinghen V, Lebigot J, Lapuyade B, Cales P, et al. Liver stiffness in nonalcoholic fatty liver disease: A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy. Hepatology 2016;63:1817-1827.
137. de Ledinghen V, Wong GL, Vergniol J, Chan HL, Hiriart JB, Chan AW, et al. Controlled attenuation parameter for the diagnosis of steatosis in non-alcoholic fatty liver disease. J Gastroenterol Hepatol 2016;31:848-855.
138. Yilmaz Y, Yesil A, Gerin F, Ergelen R, Akin H, Celikel CA, et al. Detection of hepatic steatosis using the controlled attenuation parameter: a comparative study with liver biopsy. Scand J Gastroenterol 2014;49:611-616.
139. Gu Q, Cen L, Lai J, Zhang Z, Pan J, Zhao F, et al. A meta-analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease. Eur J Clin Invest 2021;51:e13446.
140. Kodama Y, Ng CS, Wu TT, Ayers GD, Curley SA, Abdalla EK, et al. Comparison of CT methods for determining the fat content of the liver. AJR Am J Roentgenol 2007;188:1307-1312.
141. Rogier J, Roullet S, Cornelis F, Biais M, Quinart A, Revel P, et al. Noninvasive assessment of macrovesicular liver steatosis in cadaveric donors based on computed tomography liver-to-spleen attenuation ratio. Liver Transpl 2015;21:690-695.
142. Gu J, Liu S, Du S, Zhang Q, Xiao J, Dong Q, et al. Diagnostic value of MRIPDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: a meta-analysis. Eur Radiol 2019;29:3564-3573.
143. Tang A, Desai A, Hamilton G, Wolfson T, Gamst A, Lam J, et al. Accuracy of MR imaging-estimated proton density fat fraction for classification of dichotomized histologic steatosis grades in nonalcoholic fatty liver disease. Radiology 2015;274:416-425.
144. Noureddin M, Lam J, Peterson MR, Middleton M, Hamilton G, Le TA, et al. Utility of magnetic resonance imaging versus histology for quantifying changes in liver fat in nonalcoholic fatty liver disease trials. Hepatology 2013;58:1930-1940.
145. Middleton MS, Heba ER, Hooker CA, Bashir MR, Fowler KJ, Sandrasegaran K, et al. Agreement Between Magnetic Resonance Imaging Proton Density Fat Fraction Measurements and Pathologist-Assigned Steatosis Grades of Liver Biopsies From Adults With Nonalcoholic Steatohepatitis. Gastroenterology 2017;153:753-761.
146. Singh S, Venkatesh SK, Loomba R, Wang Z, Sirlin C, Chen J, et al. Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis. Eur Radiol 2016;26:1431-1440.
147. Brunt EM, Wong VW, Nobili V, Day CP, Sookoian S, Maher JJ, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primers 2015;1:15080.
148. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999;94:2467-2474.
149. Takahashi Y, Fukusato T. Histopathology of nonalcoholic fatty liver disease/ nonalcoholic steatohepatitis. World J Gastroenterol 2014;20:15539-15548.
150. Bedossa P, Poitou C, Veyrie N, Bouillot JL, Basdevant A, Paradis V, et al. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology 2012;56:1751-1759.
151. Drescher HK, Weiskirchen S, Weiskirchen R. Current Status in Testing for Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH). Cells 2019;8.
152. Kleiner DE, Brunt EM. Nonalcoholic fatty liver disease: pathologic patterns and biopsy evaluation in clinical research. Semin Liver Dis 2012;32:3-13.
153. Wang L SY, Chan AWH. Pathology of Non-lcoholic fatty liver disease. Int J Dig Dis 2016;2:1.
154. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-1321.
155. Bedossa P AJ, Davies S, et al. The EPoS staging system is a reproducible 7-tier fibrosis score for NAFLD adapted both to glass slides and digitized images (eslides). J Hepatol 2018;68:S553.
156. Bedossa P, Consortium FP. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology 2014;60:565-575.
157. Bedossa P. Pathology of non-alcoholic fatty liver disease. Liver Int 2017;37 Suppl 1:85-89.
158. Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010;362:1675-1685.
159. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348:1625-1638.
160. Larsson SC, Wolk A. Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies. Br J Cancer 2007;97:1005-1008.
161. Schlesinger S, Aleksandrova K, Pischon T, Fedirko V, Jenab M, Trepo E, et al. Abdominal obesity, weight gain during adulthood and risk of liver and biliary tract cancer in a European cohort. Int J Cancer 2013;132:645-657.
162. El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: A systematic review of epidemiologic evidence. Clinical Gastroenterology and Hepatology 2006;4:369-380.
163. Dyson J, Jaques B, Chattopadyhay D, Lochan R, Graham J, Das D, et al. Hepatocellular cancer: The impact of obesity, type 2 diabetes and a multidisciplinary team. Journal of Hepatology 2014;60:110-117.
164. Bruix J, Sherman M. Management of Hepatocellular Carcinoma: An Update. Hepatology 2011;53:1020-1022.
165. Reig M, Gambato M, Man NK, Roberts JP, Victor D, Orci LA, et al. Should Patients With NAFLD/NASH Be Surveyed for HCC? Transplantation 2019;103:39-44.
166. White DL, Kanwal F, El-Serag HB. Association Between Nonalcoholic Fatty Liver Disease and Risk for Hepatocellular Cancer, Based on Systematic Review. Clinical Gastroenterology and Hepatology 2012;10:1342-1359.
167. Kim GA, Lee HC, Choe J, Kim MJ, Lee MJ, Chang HS, et al. Association between non-alcoholic fatty liver disease and cancer incidence rate. Journal of Hepatology 2018;68:140-146.
168. Younossi ZM, Loomba R, Anstee QM, Rinella ME, Bugianesi E, Marchesini G, et al. Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. Hepatology 2018;68:349-360.
169. Loomba R, Lim JK, Patton H, El-Serag HB. AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology 2020;158:1822- 1830.
170. Mittal S, Sada YH, El-Serag HB, Kanwal F, Duan Z, Temple S, et al. Temporal Trends of Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma in the Veteran Affairs Population. Clinical Gastroenterology and Hepatology 2015;13:594-601.
171. Younes R, Bugianesi E. Should we undertake surveillance for HCC in patients with NAFLD? Journal of Hepatology 2018;68:326-334.
172. Bhala N, Angulo P, van der Poorten D, Lee E, Hui JM, Saracco G, et al. The Natural History of Nonalcoholic Fatty Liver Disease With Advanced Fibrosis or Cirrhosis: An International Collaborative Study. Hepatology 2011;54:1208- 1216.
173. Welzel TM, Graubard BI, Zeuzem S, El-Serag HB, Davila JA, McGlynn KA. Metabolic Syndrome Increases the Risk of Primary Liver Cancer in the United States: A Study in the SEER-Medicare Database. Hepatology 2011;54:463-471.
174. Mittal S, El-Serag HB, Sada YH, Kanwal F, Duan ZG, Temple S, et al. Hepatocellular Carcinoma in the Absence of Cirrhosis in United States Veterans Is Associated With Nonalcoholic Fatty Liver Disease. Clinical Gastroenterology and Hepatology 2016;14:124-31.e1.
175. Liu YL, Patman GL, Leathart JBS, Piguet AC, Burt AD, Dufour JF, et al. Carriage of the PNPLA3 rs738409 C > G polymorphism confers an increased risk of non-alcoholic fatty liver disease associated hepatocellular carcinoma. J Hepatol 2014;61:75-81.
176. Berna G, Romero-Gomez M. The role of nutrition in non-alcoholic fatty liver disease: Pathophysiology and management. Liver Int 2020;40 Suppl 1:102-108.
177. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology 2015;149:367-378 e365; quiz e314-365.
178. Aller R, Siguenza R, Pina M, Laserna C, Antolin B, Burgueno B, et al. Insulin resistance is related with liver fibrosis in type 2 diabetic patients with non-alcoholic fatty liver disease proven biopsy and Mediterranean diet pattern as a protective factor. Endocrine 2020;68:557-563.
179. Cai H, Qin YL, Shi ZY, Chen JH, Zeng MJ, Zhou W, et al. Effects of alternate-day fasting on body weight and dyslipidaemia in patients with non-alcoholic fatty liver disease: a randomised controlled trial. BMC Gastroenterol 2019;19:219.
180. Yesil A, Yilmaz Y. Review article: coffee consumption, the metabolic syndrome and non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2013;38:1038-1044.
181. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018;392:1015-1035.
182. Theodoridis X, Grammatikopoulou MG, Petalidou A, Kontonika SM, Potamianos SP, Bogdanos DP. A Systematic Review of Medical Nutrition Therapy Guidelines for Liver Cirrhosis: Do We Agree? Nutr Clin Pract 2020;35:98-107.
183. Purnak T, Yilmaz Y. Liver disease and malnutrition. Best Pract Res Clin Gastroenterol 2013;27:619-629.
184. Tsien CD, McCullough AJ, Dasarathy S. Late evening snack: exploiting a period of anabolic opportunity in cirrhosis. J Gastroenterol Hepatol 2012;27:430- 441.
185. Moss O. Nutrition priorities: Diet recommendations in liver cirrhosis. Clin Liver Dis (Hoboken) 2019;14:146-148.
186. Perdomo CM, Fruhbeck G, Escalada J. Impact of nutritional changes on nonalcoholic fatty liver disease. Nutrients 2019;11.
187. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011;43:1334-1359.
188. Wang ST, Zheng J, Peng HW, Cai XL, Pan XT, Li HQ, et al. Physical activity intervention for non-diabetic patients with non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials. BMC Gastroenterol 2020;20:66.
189. Orci LA, Gariani K, Oldani G, Delaune V, Morel P, Toso C. Exercise-based Interventions for Nonalcoholic Fatty Liver Disease: A Meta-analysis and Metaregression. Clin Gastroenterol Hepatol 2016;14:1398-1411.
190. Zhang HJ, He J, Pan LL, Ma ZM, Han CK, Chen CS, et al. Effects of moderate and vigorous exercise on nonalcoholic fatty liver disease: A randomized clinical Trial. JAMA Intern Med 2016;176:1074-1082.
191. Stoica RA, Rizzo M, Ştefan DS, Rizzo M, Suceveanu AI, Suceveanu AP, et al. Metformin Indications, Dosage, Adverse Reactions, and Contraindications. In: Stoian AMP, Rizzo RM editor. Metformin. Rijeka: IntechOpen; 2020.
192. Li Y, Liu L, Wang B, Wang J, Chen D. Metformin in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Biomed Rep 2013;1:57-64.
193. Said A, Akhter A. Meta-Analysis of Randomized Controlled Trials of Pharmacologic Agents in Non-alcoholic Steatohepatitis. Ann Hepatol 2017;16:538- 547.
194. Zhang X, Harmsen WS, Mettler TA, Kim WR, Roberts RO, Therneau TM, et al. Continuation of metformin use after a diagnosis of cirrhosis significantly improves survival of patients with diabetes. Hepatology 2014;60:2008-2016.
195. Koenen TB, Tack CJ, Kroese JM, Hermus AR, Sweep FCG, Laak van der J, et al. Pioglitazone treatment enlarges subcutaneous adipocytes in insulin-resistant patients. J Clin Endocrinol Metab 2009;94:4453-4457.
196. McLaughlin TM, Liu T, Yee G, Abbasi F, Lamendola C, Reaven GM, et al. Pioglitazone increases the proportion of small cells in human abdominal subcutaneous adipose tissue. Obesity 2010;18:926-931.
197. Kajita K, Mori I, Hanamoto T, Ikeda T, Fujioka K, Yamauchi M,et al. Pioglitazone enhances small-sized adipocyte proliferation in subcutaneous adipose tissue. Endocr J 2012;59:1107-1114.
198. Musso G, Cassader M, Paschetta E, Gambino R. Pioglitazone for advanced fibrosis in nonalcoholic steatohepatitis: New evidence, new challenges. Hepatology 2017;65:1058-1061.
199. Belfort R, Harrison SA, Brown K, Darland C, Finch J, Hardies J, et al. A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis.N Engl J Med 2006;355:2297-2307.
200. Aithal GP, Thomas JA, Kaye PV, Lawson A, Ryder SD, Spendlove I, et al. Randomized, placebo-controlled trial of pioglitazone in nondiabetic subjects with nonalcoholic steatohepatitis. Gastroenterology 2008;135:1176-1184.
201. Cusi K, Orsak B, Bril F, Lomonaco R, Hecht J, Lopez CO, et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or Type 2 Diabetes Mellitus: A randomized trial. Ann Intern Med 2016;165:305-315.
202. Portillo-Sanchez P, Bril F, Lomonaco R, Barb D, Orsak B, Bruder JM, et al. Effect of pioglitazone on bone mineral density in patients with nonalcoholic steatohepatitis: A 36-month clinical trial. J Diabetes 2019;11:223-231.
203. Bełtowski J, Rachańczyk J, Włodarczyk M. Thiazolidinedione-induced fluid retention: Recent insights into the molecular mechanisms. PPAR Res 2013;2013:628628.
204. Zhu Z-N, Jiang Y-F, Ding T. Risk of fracture with thiazolidinediones: an updated meta-analysis of randomized clinical trials. Bone 2014;68:115-123.
205. Ohki T, Isogawa A, Iwamoto M, Ohsugi M, Yoshida H, Toda N, et al. The effectiveness of liraglutide in nonalcoholic fatty liver disease patients with type 2 diabetes mellitus compared to sitagliptin and pioglitazone. Sci World Journal 2012;2012:496453.
206. Mantovani A, Beatrice G, Petracca G, Pampagnin F, Sandri D, Targher G. GLP1 receptor agonists for NAFLD treatment in patients with and without type 2 diabetes: an updated meta-analysis. Explor Med 2020;1:1-108.
207. Armstrong MJ, Gaunt P, Aithal GP, Barton D, Hull D, Parker R, et al. Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet 2016;387:679-690.
208. Bril F, Biernacki DM, Kalavalapalli S, Lomonaco R, Subbarayan SK, Lai J, et al. Role of vitamin E for nonalcoholic steatohepatitis in patients withType 2 diabetes: A randomized controlled trial. Diabetes Care 2019;42:1481-1488.
209. Parikh P, Ingle M, Patel J, Bhate P, Pandey V, Sawant P. An openlabel randomized control study to compare the efficacy of Vitamin E versusursodeoxycholic acid in nondiabetic and noncirrhotic Indian NAFLD patients. Saudi J Gastroenterol 2016;22:192-197.
210. Caldwell S. NASH Therapy: Omega 3 supplementation, vitamin E, insulin sensitizers and statin drugs. Clin Mol Hepatol 2017;23:103-108.
211. Schürks M, Glynn RJ, Rist PM, Tzourio C, Kurth T. Effects of vitamin E on stroke subtypes: Meta-analysis of randomised controlled trials.BMJ 2010;341:c5702.
212. Cheng P, Wang L, Ning S, Liu Z, Lin H, Chen S,et al. Vitamin E intake and risk of stroke: A meta-analysis. Br J Nutr 2018;120:1181-1188.
213. Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: High-dosage vitamin E supplementation may increaseall- cause mortality. Ann Inter Med 2005;142:37-46.
214. Klein EA, Thompson IM Jr, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin ECancer Prevention Trial (SELECT). JAMA 2011;306:1549-1556.
215. Olkkonen VM. Oxysterols and oxysterol-binding proteins in cellular lipid metabolism. In: Cellular Lipid Metabolism. Berlin: Springer Berlin Heidelberg; 2009.
216. Pramfalk C, Parini P, Gustafsson U, Sahlin S, Eriksson M. Effects of high-dose statin on the human hepatic expression of genes involved incarbohydrate and triglyceride metabolism. J Intern Med 2011;269:333-339.
217. Quist-Paulsen P. Statins and inflammation: an update. Curr Opin Cardiol 2010;25:399-405.
218. Gomez-Dominguez E, Gisbert JP, Moreno-Monteagudo JA, Garcia-Buey L, Moreno-Otero R. A pilot study of atorvastatin treatment indyslipemid, non-alcoholic fatty liver patients. Aliment Pharmacol Ther 2006;23:1643-1647.
219. Antonopoulos S, Mikros S, Mylonopoulou M, Kokkoris S, Giannoulis G. Rosuvastatin as a novel treatment of non-alcoholic fatty liver disease in hyperlipidemic patients. Atherosclerosis 2006;184:233-234.
220. Abel T, Feher J, Dinya E, Eldin MG, Kovacs A. Safety and efficacy of combined ezetimibe/simvastatin treatment and simvastatin monotherapyin patients with non-alcoholic fatty liver disease. Med Sci Monit 2009;15:MS6-MS11.
221. Ekstedt M, Franzen LE, Mathiesen UL, Holmqvist M, Bodemar G, Kechagias S. Statins in non-alcoholic fatty liver disease and chronically elevated liver enzymes: A histopathological follow-up study. J Hepatol 2007;47:135-141.
222. Bril F, Portillo Sanchez P, Lomonaco R, Orsak B, Hecht J, Tio F, et al. Liver safety of statins in prediabetes or T2DM and nonalcoholic steatohepatitis: Post Hoc analysis of a randomized trial. J Clin Endocrinol Metab 2017;102:2950-2961.
223. FDA. FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs. Last Accessed Date: 18.04.2023 Available at: https://www.fda.gov/drugs/drug-safety-and-availability /fda-drug-safety-communication-important-safety-label-changes -cholesterol-lowering-statin-drugs
224. Idzior-Walus B, Sieradzki J, Rostworowski W, Zdzienicka A, Kawalec E, Wojcik J, et al. Effects of comicronised fenofibrate on lipid and insulin sensitivity in patients with polymetabolic syndrome X. Eur J Clin Invest 2000;30:871-878.
225. Fernandez-Miranda C, Perez-Carreras M, Colina F, Lopez-Alonso G, Vargas C, Heruzo JAS. A pilot trial of fenofibrate for the treatment of non-alcoholic fatty liver disease. Dig Liver Dis 2008;40:200-205.
226. Gandhi N, Lenton R, Bhartia M, Abbas A, Raju J, Ramachandran S. Effect of fibrate treatment on liver function tests in patients with the metabolic syndrome. Springerplus 2014;3:14.
227. Borem LMA, Neto JFR, Brandi IV, Lelis DF, Santos SHS. The role of the angiotensin II type I receptor blocker telmisartan in the treatment of nonalcoholic fatty liver disease: a brief review. Hypertens Res 2018;41:394-405.
228. Santos RA, Ferreira AJ, Verano-Braga T, Bader M. Angiotensin-converting enzyme 2, angiotensin-(1-7) and Mas: new players of the renin-angiotensin system. J Endocrinol 2013;216:R1-R17.
229. Alam S, Abrar M, Islam S, Kamal M, Hasan MJ, Khan AS, et al. Effect of telmisartan and vitamin E on liver histopathology with non-alcoholic steatohepatitis:A randomized, open-label, noninferiority trial. JGH Open 2020;4:663-669.
230. Park JG, Mok JS, Han YI, Park TS, Kang KW, Choi CS,et al. Connectivity mapping of angiotensin-PPAR interactions involved in the amelioration of nonalcoholic steatohepatitis by Telmisartan. Sci Rep 2019;9:4003.
231. Lindor KD, Kowdley KV, Heathcote EJ, Harrison ME, Jorgensen R, et al. Ursodeoxycholic acid for treatment of nonalcoholic steatohepatitis:results of a randomized trial. Hepatology 2004;39:770-778.
232. Leuschner UF, Lindenthal B, Herrmann G, Arnold JC, Rossle M, Cordes HJ, et al. High-dose ursodeoxycholic acid therapy for nonalcoholic steatohepatitis:a double-blind, randomized, placebo-controlled trial. Hepatology 2010;52:472-479.
233. Dufour JF, Oneta CM, Gonvers JJ, Bihl F, Cerny A, Cereda JM, et al. Randomized placebo-controlled trial of ursodeoxycholic acid with vitamin e in nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2006;4:1537-1543.
234. Musa-Veloso K, Venditti C, Lee HY, Darch M, Floyd S, West S, et al. Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease. Nutr Rev 2018;76:581-602.
235. He XX, Wu XL, Chen RP, Chen C, Liu XG, Wu BJ, et al. Effectiveness of omega-3 polyunsaturated fatty acids in non-alcoholic fatty liver disease: A meta-analysis of randomized controlled trials. PLoS One 2016;11:e0162368
236. Zhong S, Fan Y, Yan Q, Fan X, Wu B, Han Y, et al. The therapeutic effect of silymarin in the treatment of nonalcoholic fatty disease:A meta-analysis (PRISMA) of randomized control trials. Medicine (Baltimore) 2017;96:e9061.
237. Neuschwander-Tetri BA, Loomba R, Sanyal AJ, Lavine JE, Van Natta ML, Abdelmalek MF, et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015;385:956-965.
238. Younossi ZM, Ratziu V, Loomba R, Rinella M, Anstee QM, Goodman Z, et al. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial. Lancet 2019;394:2184-2196.
239. Ratziu V, Harrison SA, Francque S, Bedossa P, Lehert P, Servaty L, et al. Elafibranor, an agonist of the peroxisome proliferator-activated receptor-alpha and -delta, induces resolution of nonalcoholic steatohepatitis without fibrosis worsening. Gastroenterology 2016;150:1147-1159.e5. Erratum in: Gastroenterology 2017;152:2084.
240. Ratziu V, Sanyal A, Harrison SA, Wong VW, Francque S, Goodman Z, et al. Cenicriviroc treatment for adults with nonalcoholic steatohepatitis and fibrosis:Final analysis of the Phase 2b CENTAUR Study. Hepatology 2020;72:892-905.
241. Loomba R, Lawitz E, Mantry PS, Jayakumar S, Caldwell SH, Arnold H, et al. The ASK1 inhibitor selonsertib in patients with nonalcoholic steatohepatitis A randomized, phase 2 trial. Hepatology 2018;67:549-559.
242. Gilead Announces Topline Data From Phase 3 STELLAR-3 Study of Selonsertib in Bridging Fibrosis (F3) Due to Nonalcoholic Steatohepatitis(NASH). Last Accessed Date: 18.04.2023. Available at: https://www.gilead.com/newsand-press/press-room/press-releases/2019/4/gilead-announces-topline-datafrom-phase-3-stellar3-study-of-selonsertib-in-bridging-fibrosis -f3-due-to-nonalcoholic-steatohepatitis-nash
243. Gilead Announces Topline Data From Phase 3 STELLAR-4 Study of Selonsertib in Compensated Cirrhosis (F4) Due to Nonalcoholic Steatohepatitis (NASH). Last Accessed Date: 18.04.2023. Available at: https:// www.gilead.com /news-and-press/press-room/press-releases/2019/2/gilead -announces-topline-data-from-phase-3-stellar4-study-of -selonsertib-in-compensated-cirrhosis-f4-due -to-nonalcoholic-steatohepatitis-nash
244. Harrison SA, Bashir MR, Guy CD, Zhou R, Moylan CA, Frias JP, et al. Resmetirom (MGL-3196) for the treatment of non-alcoholic steatohepatitis: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial. Lancet 2019;394:2012-2024.
245. Look A. HEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring) 2014;22:5- 13.
246. Daniel S, Soleymani T, Garvey WT. A complications-based clinical staging of obesity to guide treatment modality and intensity. Curr Opin Endocrinol Diabetes Obes 2013;20:377-388.
247. ASGE Bariatric Endoscopy Task Force, Sullivan S, Kumar N, Edmundowicz SA, Abu Dayyeh BK, Jonnalagadda SS, Larsen M, et al. ASGE position statement on endoscopic bariatric therapies in clinical practice. Gastrointest Endosc 2015;82:767-772.
248. Türkiye Beslenme ve Sağlık Araştırması 2010. Son Erişim Tarihi: 05.06.2020. https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-hareketli-hayat-db/ Yayinlar/kitaplar/diger-kitaplar/TBSA-Beslenme-Yayini.pdf
249. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724- 1737.
250. Karlsson J, Taft C, Ryden A, Sjostrom L, Sullivan M. Ten-year trends in healthrelated quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond) 2007;31:1248-1261.
251. Carlsson LMS, Sjoholm K, Karlsson C, Jacobson P, Andersson-Assarsson JC, Svensson PA, et al. Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycaemic status: a post-hoc analysis of participants from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol 2017;5:271-279.
252. IFSO. Son Erişim tarihi: 11.08.2020. https://www.ifso.com/are-you-a-candidate/
253. Luo RB, Suzuki T, Hooker JC, Covarrubias Y, Schlein A, Liu S, et al. How bariatric surgery affects liver volume and fat density in NAFLD patients. Surg Endosc 2018;32:1675-1682.
254. Yu Y, Klem ML, Kalarchian MA, Ji M, Burke LE. Predictors of weight regain after sleeve gastrectomy: an integrative review. Surg Obes Relat Dis 2019;15:995-1005.
255. Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Morillas R, et al. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 2011;54:555-561.
256. Shimizu H, Phuong V, Maia M, Kroh M, Chand B, Scauer PR, et al. Bariatric surgery in patients with liver cirrhosis. Surg Obes Relat Dis 2013;9:1-6.
257. Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol 2011;9:897- 901.
258. Jan A, Narwaria M, Mahawar KK. A systematic review of bariatric surgery in patients with liver cirrhosis. Obes Surg 2015;25:1518-1526.
259. Heimbach JK, Watt KD, Poterucha JJ, Ziller NF, Cecco SD, Charlton MR, et al. Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. Am J Transplant 2013;13:363-368.
260. Lin MY, Tavakol MM, Sarin A, Amirkiai SM, Rogers SJ, Carter JT, et al. Safety and feasibility of sleeve gastrectomy in morbidly obese patients following liver transplantation. Surg Endosc 2013;27:81-85.
261. Cholankeril G, Ahmed A. Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States. Clin Gastroenterol Hepatol 2018;16:1356-1358.
262. Martin P, DiMartini A, Feng S, Brown R, Jr, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology 2014;59:1144-1165.
263. Golabi P, Bush H, Stepanova M, Locklear CT, Jacobson IM, Mishra A, et al. Liver transplantation (LT) for cryptogenic cirrhosis (CC) and nonalcoholic steatohepatitis (NASH) cirrhosis: Data from the Scientific Registry of Transplant Recipients (SRTR): 1994 to 2016. Medicine (Baltimore) 2018;97:e11518.
264. Haldar D, Kern B, Hodson J, Armstrong MJ, Adam R, Berlakovich G, et al. Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study. J Hepatol 2019;71:313-322.
265. Mikolasevic I, Filipec-Kanizaj T, Mijic M, Jakopcic I, Milic S, Hrstic I, et al. Nonalcoholic fatty liver disease and liver transplantation - Where do we stand? World J Gastroenterol 2018;24:1491-1506.
266. Dare AJ, Plank LD, Phillips AR, Gane EJ, Harrison B, Orr D, et al. Additive effect of pretransplant obesity, diabetes, and cardiovascular risk factors on outcomes after liver transplantation. Liver Transpl 2014;20:281-290.
267. Cotter TG, Charlton M. Nonalcoholic steatohepatitis after liver transplantation. Liver Transpl 2020;26:141-159.
268. Germani G, Laryea M, Rubbia-Brandt L, Egawa H, Burra P, O’Grady J, et al. Management of recurrent and de novo NAFLD/NASH after liver transplantation. Transplantation 2019;103:57-67.
269. Vallin M, Guillaud O, Boillot O, Hervieu V, Scoazec JY, Dumortier J. Recurrent or de novo nonalcoholic fatty liver disease after liver transplantation:natural history based on liver biopsy analysis. Liver Transpl 2014;20:1064-1071.
270. Galvin Z, Rajakumar R, Chen E, Adeyi O, Selzner M, Grant D, et al. Predictors of de novo nonalcoholic fatty liver disease after liver transplantationand associated fibrosis. Liver Transpl 2019;25:56-67.
271. Younossi ZM, Loomba R, Rinella ME, Bugianesi E, Marchesini G, Neuschwander-Tetri BA, et al. Current and future therapeutic regimens for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology 2018;68:361- 371.
272. Suraweera D, Saab EG, Choi G, Saab S. Bariatric surgery and liver transplantation. Gastroenterol Hepatol (NY) 2017;13:170-175.
273. Diwan TS, Rice TC, Heimbach JK, Schauer DP. Liver transplantation and bariatric surgery: Timing and outcomes. Liver Transpl 2018;24:1280-1287.
274. Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R, et al. NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr 2017;64:319-334.
275. Mann JP, Valenti L, Scorletti E, Byrne CD, Nobili V. Nonalcoholic fatty liver disease in children. Semin Liver Dis 2018;38:1-13.
276. Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Bauman U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 2012;54:700-713.
277. Schwimmer JB, Behling C, Newbury R, Deutsch R, Nievergelt C, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005;42:641-649.
278. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics 2006;118:1388-1393.
279. A-Kader HH, Henderson J, Vanhoesen K, Ghishan F, Bhattacharyya A. Nonalcoholic fatty liver disease in children: a single center experience.Clin Gastroenterol Hepatol 2008;6:799-802.
280. Anderson EL, Howe LD, Jones HE, Higgins JP, Lawlor DA, Fraser A. The prevalence of non-alcoholic fatty liver disease in children and adolescents:A systematic review and meta-analysis. PLoS One 2015;10:e0140908.
281. Yu EL, Golshan S, Harlow KE, Angeles JE, Durelle J, Goyal NP, et al. Prevalence of nonalcoholic fatty liver disease in children with obesity. J Pediatr 2019;207:64-70.
282. Braun HA, Faasse SA, Vos MB. Advances in pediatric fatty liver disease: pathogenesis, diagnosis, and treatment. Gastroenterol Clin North Am 2018;47:949- 968.
283. Barrera F, George J. The role of diet and nutritional intervention for the management of patients with NAFLD. Clin Liver Dis 2014;18:91-112.
284. Chiu S, Sievenpiper JL, de Souza RJ, Cozma AI, Mirrahimi A, Carleton AJ, et al. Effect of fructose on markers of non-alcoholic fatty liver disease (NAFLD):a systematic review and meta-analysis of controlled feeding trials. Eur J Clin Nutr 2014;68:416-423.
285. Rehm JL, Connor EL, Wolfgram PM, Eickhoff JC, Reeder SB, Allen DB. Predicting hepatic steatosis in a racially and ethnically diverse cohort of adolescent girls. J Pediatr 2014;165:319-325.e1.
286. Wiegand S, Keller KM, Robl M, L’Allemand D, Reinehr T, Widhalm K, et al; APV-Study Group and the German Competence Network Adipositas. Obese boys at increased risk for nonalcoholic liver disease: evaluation of 16,390 overweight or obese children and adolescents. Int J Obes (Lond) 2010;34:1468-1474.
287. Malespin M, Sleesman B, Lau A, Wong SS, Cotler SJ. Prevalence and correlates of suspected nonalcoholic fatty liver disease in Chinese American children. J Clin Gastroenterol 2015;49:345-349.
288. Kong L, Lu Y, Zhang S, Nan Y, Qiao L. Role of nutrition, gene polymorphism, and gut microbiota in non-alcoholic fatty liver disease. Discov Med 2017;24:95- 106.
289. Brumbaugh DE, Tearse P, Cree-Green M, Fenton LZ, Brown M, Scherzinger A, et al. Intrahepatic fat is increased in the neonatal offspring of obese women with gestational diabetes. J Pediatr 2013;162:930-936.e1.
290. Brumbaugh DE, Friedman JE. Developmental origins of nonalcoholic fatty liver disease. Pediatr Res 2014;75:140-147.
291. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999;116:1413-1419.
292. Cioffi CE, Welsh JA, Cleeton RL, Caltharp SA, Romero R, Wulkan ML, et al. Natural history of NAFLD diagnosed in childhood: A single-center study.Children (Basel) 2017;4:34.
293. Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut 2009;58:1538-1544.
294. Xanthakos S, Lavine JE, Yates KP, Schwimmer JB, Molleston JP, Rosenthal P, et al. Natural history of nonalcoholic fatty liver disease (NAFLD) in children receiving standard lifestyle counseling and placebo in NASH Clinical Research Network (CRN) trials. Hepatology 2017;66:31A-32A.
295. Schwimmer JB, Celedon MA, Lavine JE, Salem R, Campbell N, Schork NJ, et al. Heritability of nonalcoholic fatty liver disease. Gastroenterology 2009;136:1585-1592.
296. Molleston JP, Schwimmer JB, Yates KP, Murray KF, Cummings OW,Lavine JE, et al. Histological abnormalities in children with nonalcoholic fatty liver disease and normal or mildly elevated alanine aminotransferase levels. J Pediatr 2014;164:707-3.e3.
297. Schwimmer JB, Newton KP, Awai HI, Choi LJ, Garcia MA, Ellis LL, et al. Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2013;38:1267-1277.
298. Awai HI, Newton KP, Sirlin CB, Behling C, Schwimmer JB. Evidence and recommendations for imaging liver fat in children, based on systematic review. Clin Gastroenterol Hepatol 2014;12:765-773.
299. Nobili V, Alisi A, Vania A, Tiribelli C, Pietrobattista A, Bedogni G. The pediatric NAFLD fibrosis index: a predictor of liver fibrosis in children with nonalcoholic fatty liver disease. BMC Med 2009;7:21.
300. Yang HR, Kim HR, Kim MJ, Ko JS, Seo JK. Noninvasive parameters and hepatic fibrosis scores in children with nonalcoholic fatty liver disease.World J Gastroenterol 2012;18:1525-1530.
301. Alkhouri N, Carter-Kent C, Lopez R, Rosenberg WM, Pinzani M, Bedogni G, et al. A combination of the pediatric NAFLD fibrosis index and enhanced liver fibrosis test identifies children with fibrosis. Clin Gastroenterol Hepatol 2011;9:150-155.
302. Alkhouri N, Mansoor S, Giammaria P, Liccardo D, Lopez R, Nobili V. The development of the pediatric NAFLD fibrosis score (PNFS) to predict the presence of advanced fibrosis in children with nonalcoholic fatty liver disease. PLoS One 2014;9:e104558.
303. Tutar E, Akkelle B, Kesici CB, Yılmaz Y, Celikel CA, et al. The correlation between histopathologic steatosis/fibrosis and various non-invasive imaging and blood fibrosis indicators in children with NAFLD. J Pediatr Gastroenterol Nutr 2018;66(Suppl 2):646A.
304. Mansoor S, Collyer E, Alkhouri N. A comprehensive review of noninvasive liver fibrosis tests in pediatric nonalcoholic Fatty liver disease. Curr Gastroenterol Rep 2015;17:23.
305. Shah J, Okubote T, Alkhouri N. Overview of updated practice guidelines for pediatric nonalcoholic fatty liver disease. Gastroenterol Hepatol (N Y) 2018;14:407-414.
306. Kleiner DE, Makhlouf HR. Histology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in adults and children. Clin Liver Dis 2016;20:293- 312.
307. Dezsofi A, Baumann U, Dhawan A, Durmaz O, Fischler B, Hadzig N, et al. Liver biopsy in children: position paper of the ESPGHAN Hepatology Committee.J Pediatr Gastroenterol Nutr 2015;60:408-420.
308. Crespo M, Lappe S, Feldstein AE, Alkhouri N. Similarities and differences between pediatric and adult nonalcoholic fatty liver disease.Metabolism 2016;65:1161-1171.
309. DeVore S, Kohli R, Lake K, Nicholas L, Dietrich K, Balistreri WF,et al. A multidisciplinary clinical program is effective in stabilizing BMI and reducing transaminase levels in pediatric patients with NAFLD. J Pediatr Gastroenterol Nutr 2013;57:119-123.
310. Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA 2008;299:1139-1148.
311. Nobili V, Alkhouri N, Bartuli A, Manco M, Lopez R, Alisi A, et al. Severity of liver injury and atherogenic lipid profile in children with nonalcoholic fatty liver disease. Pediatr Res 2010;67:665-670.
312. Pacifico L, Anania C, Martino F, Cantisani V, Pascone R, Marcantonio A, et al. Functional and morphological vascular changes in pediatric nonalcoholic fatty liver disease. Hepatology 2010;52:1643-1651.
313. Gokce S, Atbinici Z, Aycan Z, Cinar HG, Zorlu P. The relationship between pediatric nonalcoholic fatty liver disease and cardiovascular risk factors and increased risk of atherosclerosis in obese children. Pediatr Cardiol 2013;34:308- 315.
314. Schwimmer JB, Zepeda A, Newton KP, Xanthakos SA, Behling C,Hallinan EK, et al. Longitudinal assessment of high blood pressure in children with nonalcoholic fatty liver disease. PLoS One 2014;9:e112569.
315. Barlow SE, Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):S164-S192.
316. Newton KP, Hou J, Crimmins NA, Lavine JE, Barlow SE, Xanthakos SA, et al; Nonalcoholic Steatohepatitis Clinical Research Network. Prevalence of prediabetes and Type 2 Diabetes in children with nonalcoholic fatty liver disease. JAMA Pediatr 2016;170:e161971.
317. Cali AM, De Oliveira AM, Kim H, Chen S, Reyes-Mugica M, Escalera S, et al. Glucose dysregulation and hepatic steatosis in obese adolescents: is there a link? Hepatology 2009;49:1896-1903.
318. Kim G, Giannini C, Pierpont B, Feldstein AE, Santoro N, Kursawe R, et al. Longitudinal effects of MRI-measured hepatic steatosis on biomarkers of glucose homeostasis and hepatic apoptosis in obese youth. Diabetes Care 2013;36:130- 136.
319. Allen AM, Van Houten HK, Sangaralingham LR, Talwalkar JA, McCoy RG. Healthcare cost and utilization in nonalcoholic fatty liver disease: real-world data from a large US claims database. Hepatology 2018; 68: 2230-2238.
320. Yonuossi ZM, Blissett D, Blissett R, Henry L, Stepanova M, Younossi Y, et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology 2016;64:1577-1586.
321. EASL (European Association for the Study of the Liver). High cost of advanced nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) revealed but screening high-risk patients may not be cost effective EASL 2019. Last Accessed Date: 18.04.2023. Available at: https://2019.ilc-congress.eu/press-release/high-cost-of-advanced-nonalcoholic-fatty-liver-disease-non-alcoholic-steatohepatitis-nafld-nash-revealedbut-screening-high-risk-patients-may-not-be-cost-effective/
322. WHO. “COVID-19 significantly impacts health services for noncommunicable diseases” from COVID-19 significantly impacts health services for noncommunicable diseases. Last Accessed Date: 18.04.2023. Available at: https:// www.who.int/news/item/01-06-2020-covid-19-significantly-impacts-health-services-for-noncommunicable-diseases

APA	Yilmaz Y, Zeybel M, ADALI G, COSAR A, Sertesen E, Gokcan H, Bahçecioğlu İ, sahin m, TULUNAY KAYA C, ergün i, TURAN I, Idilman I, Celikel C, Kirimlioglu S, Akyol G, Yilmaz F, SOKMENSUER C, güveli h, Akarca U, Akyuz U, Genc V, AKYILDIZ M, Yazihan N, Tutar E, Ates F, Dincer D, balaban h, KIYICI M, Akdogan M, Sonsuz A, Idilman R, Yapali S, Dursun H, Aladag M, Satman I, Karcaaltincaba M, ARIKAN C, GÜLERMAN H, Selimoglu M, Özen H, Basaranoglu M, Karakan T, yurci a, Demir K, Koruk M, Uygun A, Sezgin O, Gulec S, Beşışık F, Simsek H, Hulagu S, Tozun A, Mardinoglu A, DEMİR M, DOGANAY H, akarsu m, karasu z, Kaymakoglu S, Günşar F (2023). TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. , 1 - 32. 10.14744/hf.2023.2023.0011
Chicago	Yilmaz Yusuf,Zeybel Mujdat,ADALI GUPSE,COSAR Arif Mansur,Sertesen Elif,Gokcan Hale,Bahçecioğlu İbrahim Halil,sahin mustafa,TULUNAY KAYA CANSIN,ergün ihsan,TURAN ILKER,Idilman Ilkay,Celikel Cigdem,Kirimlioglu Saime Hale,Akyol Gülen,Yilmaz Funda,SOKMENSUER CENK,güveli hakan,Akarca Ulus Salih,Akyuz Umit,Genc Volkan,AKYILDIZ Murat,Yazihan Nuray,Tutar Engin,Ates Fehmi,Dincer Dinc,balaban hatice yasemin,KIYICI Murat,Akdogan Meral,Sonsuz Abdullah,Idilman Ramazan,Yapali Suna,Dursun Hakan,Aladag Murat,Satman Ilhan,Karcaaltincaba Musturay,ARIKAN Cigdem,GÜLERMAN HACER FULYA,Selimoglu Mukadder Ayse,Özen Hasan,Basaranoglu Metin,Karakan Tarkan,yurci alper,Demir Kadir,Koruk Mehmet,Uygun Ahmet,Sezgin Orhan,Gulec Sadi,Beşışık Fatih,Simsek Halis,Hulagu Sadettin,Tozun Ayse Nurdan,Mardinoglu Adil,DEMİR MEHMET,DOGANAY HAMDI LEVENT,akarsu mesut,karasu zeki,Kaymakoglu Sabahattin,Günşar Fulya TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. (2023): 1 - 32. 10.14744/hf.2023.2023.0011
MLA	Yilmaz Yusuf,Zeybel Mujdat,ADALI GUPSE,COSAR Arif Mansur,Sertesen Elif,Gokcan Hale,Bahçecioğlu İbrahim Halil,sahin mustafa,TULUNAY KAYA CANSIN,ergün ihsan,TURAN ILKER,Idilman Ilkay,Celikel Cigdem,Kirimlioglu Saime Hale,Akyol Gülen,Yilmaz Funda,SOKMENSUER CENK,güveli hakan,Akarca Ulus Salih,Akyuz Umit,Genc Volkan,AKYILDIZ Murat,Yazihan Nuray,Tutar Engin,Ates Fehmi,Dincer Dinc,balaban hatice yasemin,KIYICI Murat,Akdogan Meral,Sonsuz Abdullah,Idilman Ramazan,Yapali Suna,Dursun Hakan,Aladag Murat,Satman Ilhan,Karcaaltincaba Musturay,ARIKAN Cigdem,GÜLERMAN HACER FULYA,Selimoglu Mukadder Ayse,Özen Hasan,Basaranoglu Metin,Karakan Tarkan,yurci alper,Demir Kadir,Koruk Mehmet,Uygun Ahmet,Sezgin Orhan,Gulec Sadi,Beşışık Fatih,Simsek Halis,Hulagu Sadettin,Tozun Ayse Nurdan,Mardinoglu Adil,DEMİR MEHMET,DOGANAY HAMDI LEVENT,akarsu mesut,karasu zeki,Kaymakoglu Sabahattin,Günşar Fulya TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. , 2023, ss.1 - 32. 10.14744/hf.2023.2023.0011
AMA	Yilmaz Y,Zeybel M,ADALI G,COSAR A,Sertesen E,Gokcan H,Bahçecioğlu İ,sahin m,TULUNAY KAYA C,ergün i,TURAN I,Idilman I,Celikel C,Kirimlioglu S,Akyol G,Yilmaz F,SOKMENSUER C,güveli h,Akarca U,Akyuz U,Genc V,AKYILDIZ M,Yazihan N,Tutar E,Ates F,Dincer D,balaban h,KIYICI M,Akdogan M,Sonsuz A,Idilman R,Yapali S,Dursun H,Aladag M,Satman I,Karcaaltincaba M,ARIKAN C,GÜLERMAN H,Selimoglu M,Özen H,Basaranoglu M,Karakan T,yurci a,Demir K,Koruk M,Uygun A,Sezgin O,Gulec S,Beşışık F,Simsek H,Hulagu S,Tozun A,Mardinoglu A,DEMİR M,DOGANAY H,akarsu m,karasu z,Kaymakoglu S,Günşar F TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. . 2023; 1 - 32. 10.14744/hf.2023.2023.0011
Vancouver	Yilmaz Y,Zeybel M,ADALI G,COSAR A,Sertesen E,Gokcan H,Bahçecioğlu İ,sahin m,TULUNAY KAYA C,ergün i,TURAN I,Idilman I,Celikel C,Kirimlioglu S,Akyol G,Yilmaz F,SOKMENSUER C,güveli h,Akarca U,Akyuz U,Genc V,AKYILDIZ M,Yazihan N,Tutar E,Ates F,Dincer D,balaban h,KIYICI M,Akdogan M,Sonsuz A,Idilman R,Yapali S,Dursun H,Aladag M,Satman I,Karcaaltincaba M,ARIKAN C,GÜLERMAN H,Selimoglu M,Özen H,Basaranoglu M,Karakan T,yurci a,Demir K,Koruk M,Uygun A,Sezgin O,Gulec S,Beşışık F,Simsek H,Hulagu S,Tozun A,Mardinoglu A,DEMİR M,DOGANAY H,akarsu m,karasu z,Kaymakoglu S,Günşar F TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. . 2023; 1 - 32. 10.14744/hf.2023.2023.0011
IEEE	Yilmaz Y,Zeybel M,ADALI G,COSAR A,Sertesen E,Gokcan H,Bahçecioğlu İ,sahin m,TULUNAY KAYA C,ergün i,TURAN I,Idilman I,Celikel C,Kirimlioglu S,Akyol G,Yilmaz F,SOKMENSUER C,güveli h,Akarca U,Akyuz U,Genc V,AKYILDIZ M,Yazihan N,Tutar E,Ates F,Dincer D,balaban h,KIYICI M,Akdogan M,Sonsuz A,Idilman R,Yapali S,Dursun H,Aladag M,Satman I,Karcaaltincaba M,ARIKAN C,GÜLERMAN H,Selimoglu M,Özen H,Basaranoglu M,Karakan T,yurci a,Demir K,Koruk M,Uygun A,Sezgin O,Gulec S,Beşışık F,Simsek H,Hulagu S,Tozun A,Mardinoglu A,DEMİR M,DOGANAY H,akarsu m,karasu z,Kaymakoglu S,Günşar F "TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease." , ss.1 - 32, 2023. 10.14744/hf.2023.2023.0011
ISNAD	Yilmaz, Yusuf vd. "TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease". (2023), 1-32. https://doi.org/10.14744/hf.2023.2023.0011

APA	Yilmaz Y, Zeybel M, ADALI G, COSAR A, Sertesen E, Gokcan H, Bahçecioğlu İ, sahin m, TULUNAY KAYA C, ergün i, TURAN I, Idilman I, Celikel C, Kirimlioglu S, Akyol G, Yilmaz F, SOKMENSUER C, güveli h, Akarca U, Akyuz U, Genc V, AKYILDIZ M, Yazihan N, Tutar E, Ates F, Dincer D, balaban h, KIYICI M, Akdogan M, Sonsuz A, Idilman R, Yapali S, Dursun H, Aladag M, Satman I, Karcaaltincaba M, ARIKAN C, GÜLERMAN H, Selimoglu M, Özen H, Basaranoglu M, Karakan T, yurci a, Demir K, Koruk M, Uygun A, Sezgin O, Gulec S, Beşışık F, Simsek H, Hulagu S, Tozun A, Mardinoglu A, DEMİR M, DOGANAY H, akarsu m, karasu z, Kaymakoglu S, Günşar F (2023). TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. Hepatology forum, 4(1), 1 - 32. 10.14744/hf.2023.2023.0011
Chicago	Yilmaz Yusuf,Zeybel Mujdat,ADALI GUPSE,COSAR Arif Mansur,Sertesen Elif,Gokcan Hale,Bahçecioğlu İbrahim Halil,sahin mustafa,TULUNAY KAYA CANSIN,ergün ihsan,TURAN ILKER,Idilman Ilkay,Celikel Cigdem,Kirimlioglu Saime Hale,Akyol Gülen,Yilmaz Funda,SOKMENSUER CENK,güveli hakan,Akarca Ulus Salih,Akyuz Umit,Genc Volkan,AKYILDIZ Murat,Yazihan Nuray,Tutar Engin,Ates Fehmi,Dincer Dinc,balaban hatice yasemin,KIYICI Murat,Akdogan Meral,Sonsuz Abdullah,Idilman Ramazan,Yapali Suna,Dursun Hakan,Aladag Murat,Satman Ilhan,Karcaaltincaba Musturay,ARIKAN Cigdem,GÜLERMAN HACER FULYA,Selimoglu Mukadder Ayse,Özen Hasan,Basaranoglu Metin,Karakan Tarkan,yurci alper,Demir Kadir,Koruk Mehmet,Uygun Ahmet,Sezgin Orhan,Gulec Sadi,Beşışık Fatih,Simsek Halis,Hulagu Sadettin,Tozun Ayse Nurdan,Mardinoglu Adil,DEMİR MEHMET,DOGANAY HAMDI LEVENT,akarsu mesut,karasu zeki,Kaymakoglu Sabahattin,Günşar Fulya TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. Hepatology forum 4, no.1 (2023): 1 - 32. 10.14744/hf.2023.2023.0011
MLA	Yilmaz Yusuf,Zeybel Mujdat,ADALI GUPSE,COSAR Arif Mansur,Sertesen Elif,Gokcan Hale,Bahçecioğlu İbrahim Halil,sahin mustafa,TULUNAY KAYA CANSIN,ergün ihsan,TURAN ILKER,Idilman Ilkay,Celikel Cigdem,Kirimlioglu Saime Hale,Akyol Gülen,Yilmaz Funda,SOKMENSUER CENK,güveli hakan,Akarca Ulus Salih,Akyuz Umit,Genc Volkan,AKYILDIZ Murat,Yazihan Nuray,Tutar Engin,Ates Fehmi,Dincer Dinc,balaban hatice yasemin,KIYICI Murat,Akdogan Meral,Sonsuz Abdullah,Idilman Ramazan,Yapali Suna,Dursun Hakan,Aladag Murat,Satman Ilhan,Karcaaltincaba Musturay,ARIKAN Cigdem,GÜLERMAN HACER FULYA,Selimoglu Mukadder Ayse,Özen Hasan,Basaranoglu Metin,Karakan Tarkan,yurci alper,Demir Kadir,Koruk Mehmet,Uygun Ahmet,Sezgin Orhan,Gulec Sadi,Beşışık Fatih,Simsek Halis,Hulagu Sadettin,Tozun Ayse Nurdan,Mardinoglu Adil,DEMİR MEHMET,DOGANAY HAMDI LEVENT,akarsu mesut,karasu zeki,Kaymakoglu Sabahattin,Günşar Fulya TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. Hepatology forum, vol.4, no.1, 2023, ss.1 - 32. 10.14744/hf.2023.2023.0011
AMA	Yilmaz Y,Zeybel M,ADALI G,COSAR A,Sertesen E,Gokcan H,Bahçecioğlu İ,sahin m,TULUNAY KAYA C,ergün i,TURAN I,Idilman I,Celikel C,Kirimlioglu S,Akyol G,Yilmaz F,SOKMENSUER C,güveli h,Akarca U,Akyuz U,Genc V,AKYILDIZ M,Yazihan N,Tutar E,Ates F,Dincer D,balaban h,KIYICI M,Akdogan M,Sonsuz A,Idilman R,Yapali S,Dursun H,Aladag M,Satman I,Karcaaltincaba M,ARIKAN C,GÜLERMAN H,Selimoglu M,Özen H,Basaranoglu M,Karakan T,yurci a,Demir K,Koruk M,Uygun A,Sezgin O,Gulec S,Beşışık F,Simsek H,Hulagu S,Tozun A,Mardinoglu A,DEMİR M,DOGANAY H,akarsu m,karasu z,Kaymakoglu S,Günşar F TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. Hepatology forum. 2023; 4(1): 1 - 32. 10.14744/hf.2023.2023.0011
Vancouver	Yilmaz Y,Zeybel M,ADALI G,COSAR A,Sertesen E,Gokcan H,Bahçecioğlu İ,sahin m,TULUNAY KAYA C,ergün i,TURAN I,Idilman I,Celikel C,Kirimlioglu S,Akyol G,Yilmaz F,SOKMENSUER C,güveli h,Akarca U,Akyuz U,Genc V,AKYILDIZ M,Yazihan N,Tutar E,Ates F,Dincer D,balaban h,KIYICI M,Akdogan M,Sonsuz A,Idilman R,Yapali S,Dursun H,Aladag M,Satman I,Karcaaltincaba M,ARIKAN C,GÜLERMAN H,Selimoglu M,Özen H,Basaranoglu M,Karakan T,yurci a,Demir K,Koruk M,Uygun A,Sezgin O,Gulec S,Beşışık F,Simsek H,Hulagu S,Tozun A,Mardinoglu A,DEMİR M,DOGANAY H,akarsu m,karasu z,Kaymakoglu S,Günşar F TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. Hepatology forum. 2023; 4(1): 1 - 32. 10.14744/hf.2023.2023.0011
IEEE	Yilmaz Y,Zeybel M,ADALI G,COSAR A,Sertesen E,Gokcan H,Bahçecioğlu İ,sahin m,TULUNAY KAYA C,ergün i,TURAN I,Idilman I,Celikel C,Kirimlioglu S,Akyol G,Yilmaz F,SOKMENSUER C,güveli h,Akarca U,Akyuz U,Genc V,AKYILDIZ M,Yazihan N,Tutar E,Ates F,Dincer D,balaban h,KIYICI M,Akdogan M,Sonsuz A,Idilman R,Yapali S,Dursun H,Aladag M,Satman I,Karcaaltincaba M,ARIKAN C,GÜLERMAN H,Selimoglu M,Özen H,Basaranoglu M,Karakan T,yurci a,Demir K,Koruk M,Uygun A,Sezgin O,Gulec S,Beşışık F,Simsek H,Hulagu S,Tozun A,Mardinoglu A,DEMİR M,DOGANAY H,akarsu m,karasu z,Kaymakoglu S,Günşar F "TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease." Hepatology forum, 4, ss.1 - 32, 2023. 10.14744/hf.2023.2023.0011
ISNAD	Yilmaz, Yusuf vd. "TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease". Hepatology forum 4/1 (2023), 1-32. https://doi.org/10.14744/hf.2023.2023.0011