Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2016; 22(36): 8226-8233
Published online Sep 28, 2016. doi: 10.3748/wjg.v22.i36.8226
Clinical guidelines of non-alcoholic fatty liver disease: A systematic review
Jin-Zhou Zhu, Kelseanna Hollis-Hansen, Xing-Yong Wan, Su-Juan Fei, Xun-Lei Pang, Fan-Dong Meng, Chao-Hui Yu, You-Ming Li
Jin-Zhou Zhu, Xing-Yong Wan, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Kelseanna Hollis-Hansen, Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, NY 14214, United States
Su-Juan Fei, Xun-Lei Pang, Department of Gastroenterology, The Affiliated Hospital, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Fan-Dong Meng, Department of Endocrinology, The Affiliated Hospital, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Author contributions: Zhu JZ collected data; Zhu JZ and Hollis-Hansen K contributed equally to the work; Hollis-Hansen K performed analyses and wrote manuscript; Wan XY, Fei SJ and Pang XL performed systematic evaluation; Meng FD revised the manuscript; Yu CH and Li YM contributed to the study design; all authors reviewed and approved the final manuscript as submitted.
Supported by the National Natural Science Foundation of China, No. 81170378 and No. 81230012.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. You-Ming Li, Professor, Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. ymli.zju@live.com
Telephone: +86-156-65170166 Fax: +86-571-87080565
Received: June 11, 2016
Peer-review started: June 15, 2016
First decision: August 8, 2016
Revised: August 11, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: September 28, 2016
Abstract
AIM

To perform a systematic review to grade guidelines and present recommendations for clinical management of non-alcoholic fatty liver disease (NAFLD).

METHODS

A database search was conducted on PubMed for guidelines published before May 2016, supplemented by reviewing relevant websites. The Appraisal of Guidelines for Research and Evaluation (ARGEE) Instrument II was a tool designed to appraise the methodological rigor and transparency in which a clinical guideline is developed and it is used internationally. It was used to appraise the quality of guidelines in this study. The inclusion criteria include: clinical NAFLD guidelines for adults, published in English, and released by governmental agencies or key organizations.

RESULTS

Eleven guidelines were included in this study. Since 2007, guidelines have been released in Asia (3 in China, 1 in South Korea, and 1 in Japan), Europe (1 in Italy), America (1 in United States and 1 in Chile) and three international agencies [European associations joint, Asia-Pacific Working Party and World Gastroenterology Organization (WGO)]. Using the ARGEE II instrument, we found US 2012 and Europe 2016 had the highest scores, especially in the areas of rigor of development and applicability. Additionally, Italy 2010 and Korea 2013 also presented comprehensive content, rigorous procedures and good applicability. And WGO 2014 offered various algorithms for clinical practice. Lastly, a practical algorithm for the clinical management was developed, based on the recommended guidelines.

CONCLUSION

This is the first systematic review of NAFLD guidelines. It may yield insights for physicians and policy-makers in the development and application of guidelines.

Keywords: Diagnosis, Management, Non-alcoholic fatty liver disease, Systematic review, Treatment

Core tip: Non-alcoholic fatty liver disease (NAFLD) is one of the leading chronic liver diseases globally. A comprehensive study of NAFLD guidelines will be useful for various stakeholders to develop and utilize guidelines. This is the first systematic review to grade NAFLD guidelines and present recommendations for the clinical management of NAFLD. Through systematically evaluating the published guidelines and offering a clinical algorithm, it may yield insights for physicians and policy-makers in the development and application of guidelines.