Nonalcoholic fatty liver disease: Evolving paradigms

Table 1 Main features and differences between Nonalcoholic Steatohepatitis Activity score and Steatosis, Activity, and Fibrosis score

	NAS	SAF
Scoring system	Steatosis + Lobular Inflammation + Ballooning: 0-8	Steatosis, Activity (Lobular Inflammation + Ballooning), Fibrosis: S0-3, A0-4, F0-4
Details of scoring	Steatosis	Steatosis
	0: < 5%	0: < 5%
	1: 5%-33%	1: 5%-33%
	2: 34%-66%	2: 34%-66%
	3: > 67%	3: > 67%
	Lobular inflammation	Lobular inflammation
	0:00	0:00
	1: < 2/20X	1: < 2/20X
	2: 2-4/20X	2: ≥ 2/20X
	3: > 4/20X
	Ballooning (number of ballooned hepatocytes)	Ballooning (size and shape of hepatocytes)
	0: None	0: normal hepatocytes
	1: Few	1: clusters, reticulated cytoplasm
	2: Many	2: enlarged hepatocytes
	Fibrosis stage	Fibrosis stage
	F0: None	F0: 0
	F1a: zone 3 perisinusoidal, delicate	F1: zone 3 perisinusoidal (all), or portal only
	F1b: perisinusoidal, dense	F2: zone 3 + portal
	F1c: portal only	F3: bridging
	F2: 1a or 1b + portal	F4: cirrhosis
	F3: bridging
	F4: cirrhosis

NAS: NASH activity score; SAF: Steatosis, Activity, and Fibrosis score; NASH: Nonalcoholic steatohepatitis.

Table 2 Drugs useful in treating nonalcoholic steatohepatitis - A neck-to-neck comparison of findings from two different meta-analytic studies

	Sawangjit et al[244]	Singh et al[243]
Fibrosis	OCA1 improves fibrosis.PTX2, TZDs plus Metformin2, TZDs plus Losartan2 might potentially be effective.	PTX1 and OCA1 improve fibrosis
Resolution of NASH	TZDs1 and Vitamin E1 use is associated with resolution of NASH	Vitamin E1, TZDs1, and OCA1 improve ballooning degeneration
NAS	PTX1, OCA1, vitamin E1, and TZDs1 improve NAS
Steatosis		PTX1, Vitamin E2, TZD1 and OCA2 significantly improve steatosis
Lobular inflammation		PTX1, TZDs1 and OCA2 significantly improve lobular Inflammation

¹High quality of evidence;

²Moderate quality of evidence. NASH: Nonalcoholic steatohepatitis; NAS: NASH activity score; OCA: Obeticholic acid; PTX: Pentoxyphylline; TZDs: Thiazolidinediones.