FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic
1
Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
2
Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
3
Department of General Internal Medicine2, Kawasaki Medical School, Okayama 700-8505, Japan
4
Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka 558-8585, Japan
5
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
6
Department of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 840-8502, Japan
7
Loco Medical General Institute, Saga 840-8502, Japan
8
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo 116-8567, Japan
9
Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
10
Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima 738-8503, Japan
11
Division of Cardiovascular Medicine, Department of Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
12
Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka 564-8567, Japan
13
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
14
Department of Advanced Gastroenterology & Hepatology, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
15
Hepatology Center, Saiseikai Suita Hospital, Osaka 564-0013, Japan
16
Japan Strategic Medical Administration Research Center (J-SMARC), Nagoya, Aichi 460-0011, Japan
*
Author to whom correspondence should be addressed.
Academic Editor: Riccardo Autelli
Life 2021, 11(2), 143; https://doi.org/10.3390/life11020143
Received: 9 January 2021 / Revised: 22 January 2021 / Accepted: 25 January 2021 / Published: 14 February 2021
(This article belongs to the Special Issue Fatty Liver Syndrome)
The prevalence of obesity or metabolic syndrome is increasing worldwide (globally metabodemic). Approximately 25% of the adult general population is suffering from nonalcoholic fatty liver disease (NAFLD), which has become a serious health problem. In 2020, global experts suggested that the nomenclature of NAFLD should be updated to metabolic-dysfunction-associated fatty liver disease (MAFLD). Hepatic fibrosis is the most significant determinant of all cause- and liver -related mortality in MAFLD. The non-invasive test (NIT) is urgently required to evaluate hepatic fibrosis in MAFLD. The fibrosis-4 (FIB-4) index is the first triaging tool for excluding advanced fibrosis because of its accuracy, simplicity, and cheapness, especially for general physicians or endocrinologists, although the FIB-4 index has several drawbacks. Accumulating evidence has suggested that vibration-controlled transient elastography (VCTE) and the enhanced liver fibrosis (ELF) test may become useful as the second step after triaging by the FIB-4 index. The leading cause of mortality in MAFLD is cardiovascular disease (CVD), extrahepatic malignancy, and liver-related diseases. MAFLD often complicates chronic kidney disease (CKD), resulting in increased simultaneous liver kidney transplantation. The FIB-4 index could be a predictor of not only liver-related mortality and incident hepatocellular carcinoma, but also prevalent and incident CKD, CVD, and extrahepatic malignancy. Although NITs as milestones for evaluating treatment efficacy have never been established, the FIB-4 index is expected to reflect histological hepatic fibrosis after treatment in several longitudinal studies. We here review the role of the FIB-4 index in the management of MAFLD.