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New diagnostic test for fatty liver disease shows promise

New research has shown a test could help diagnose fatty liver disease without the need for liver biopsy.

Prof Chris Byrne from the NIHR Southampton Biomedical Research Centre's Nutrition, Lifestyle and Metabolism theme worked closely with researchers in China to develop the test.

The results are published in the journal Hepatology International. They showed the test could reliably identify inflammation and fibrosis (scarring) of the liver. If diagnosis is made early in the liver condition, it could help save lives.

Difficult diagnosis

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new term that is being used to re-define non-alcoholic fatty liver disease (NAFLD). A diagnosis of MAFLD includes a diagnosis of fat in the liver plus the presence of increased body fat or type 2 (adult) diabetes. It is estimated to affect around a quarter of the world’s population, the number of people affected by MAFLD is increasing.

In the early stages of MAFLD, many people are unaware they have it. If MAFLD progresses, the liver becomes progressively more inflamed and scarred. It finally the liver stops working properly, requiring a liver transplant.

So it is important to diagnose MAFLD early and detect liver inflammation and scarring. The ‘gold standard’ for diagnosing liver inflammation and scarring is a liver biopsy. This allows examination of the liver under the microscope.

Liver biopsy is expensive. It also requires putting a needle into the liver, which may cause problems afterwards such as bleeding of the liver as it heals. Research is therefore focusing on avoiding liver biopsy and developing better tests that do not need one.

Developing a new diagnostic test

The researchers compared 142 patients with biopsy-confirmed MAFLD against a group of 327 people who had not been diagnosed with the disease.

They assessed various tests that detect N-terminal propeptide of type 3 collagen, a precursor protein made when scar tissue forms. They combined the best tests to create a sequential algorithm that reliably identified liver inflammation and scarring – a sign the disease is getting worse.

Prof Byrne, a University Hospital Southampton Consultant and Professor of Endocrinology & Metabolism at the NIHR Southampton Biomedical Research Centre, said:

“This new non-invasive test that includes a measurement of Pro-C3, as well as a simple scanning measure of liver stiffness, platelet levels and diabetes status shows considerable potential. The new test could remove the need for liver biopsy to reliably diagnose MAFLD. The test could be used to prioritise patients whose disease is progressing, so they can make life-saving changes to their lifestyle before it’s too late.”


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