Raíssa Silva Bacelar de Andrade, Ayane Araújo Rodrigues, Luiz Felipe de Carvalho França, Daniel Fernando Pereira Vasconcelos


Non-alcoholic fatty liver disease (NAFLD) is a liver disease, which has common characteristics, as hepatic steatosis (lipid accumulation in hepatocytes) and fibrosis of the tissue. From these characteristics, the gold standard for diagnosis of the disease is the histopathological evaluation after liver biopsy. For this evaluation, some scores are available, and the SAF score (Steatosis, Activity, Fibrosis) has recently been described for a more complete assessment of the hepatic status. The purpose of this mini-review is to report the NAFLD using this new score.


fatty liver; histology; steatosis; fibrosis


- Della PG. Isocaloric Dietary Changes and Non-Alcoholic Fatty Liver Disease in High Cardiometabolic Risk Individuals. Nutrients 2017; 26: 9(10). pii: E1065. [DOI: 10.3390/nu9101065]

- European Association for the Study of the Liver (EASL). Easl-easd-easo clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64: 1388–1402. [DOI: 10.1159/000443344]

- Abd El-Kader SM, El-Den Ashmawy EM. Non-alcoholic fatty liver disease: The diagnosis and management. World J Hepatol 2015; 7: 846-58. [DOI: 10.4254/wjh.v7.i6.846]

- Arab JP, Candia R, Zapata R. Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review. World J Gastroenterol 2014; 20: 12182-201. [DOI: 10.3748/wjg.v20.i34.12182]

- Aguirre L, Portillo MP, Hijona E, Bujanda L. Effects of resveratrol and other polyphenols in hepatic steatosis. World J Gastroenterol 2014; 20: 7366-80. [DOI: 10.3748/wjg.v20.i23.7366]

- Chalasani N. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases. Hepatology 2012; 55: 2005-2023. [DOI: 10.1002/hep.25762]

- Sachin SK, Audrey J, Ronald H. Clements, and gary a. Abrams. Spectrum of NAFLD and Diagnostic Implications of the Proposed New Normal Range for Serum ALT in Obese Women. Hepatology 2005; 42: 650-656. [DOI: 10.1002/hep.20964]

– Salamone F, Bugianesi E. Nonalcoholic fatty liver disease: The hepatic trigger of the metabolic syndrome. J Hepatol 2010;53:1146–1147. [DOI: 10.1016/j.jhep.2010.06.013]

- Takaki A, Kawai D, Yamamoto K. Multiple hits, including oxidative stress, as pathogenesis and treatment target in non-alcoholic steatohepatitis (NASH). Int J Mol Sci 2013; 14: 20704-28. [DOI: 10.3390/ijms141020704]

- Nagao Y, Kawahigashi Y, Sata M. Association of periodontal diseases and liver fibrosis in patients with HCV and/or HBV infection. Hepat Mon 2014; 14: e23264. [DOI: 10.5812/hepatmon.23264]

- Brunt EM. Nonalcoholic steatohepatitis. Semin Liver Dis 2004; 24: 3-20. [DOI: 10.1055/s-2004-823098]

- Tiniakos DG, Vos MB, Brunt EM. Nonalcoholic fatty liver disease: pathology and pathophysiology. Annu Rev Pathol 2010; 5: 145–171. [DOI: 10.1146/annurev-pathol-121808-102132]

- Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6: e1000097. [DOI: 10.1371/journal.pmed.1000097]

- Schwimmer JB, Behling C, Newbury R. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005; 42: 641–649. [DOI: 10.1002/hep.20842]

- Harwood J, Bishop P, Liu H, Nowicki M. Safety of blind percutaneous liver biopsy in obese children: a retrospective analysis. J Clin Gastroenterol 2010; 44: e253–e255. [DOI: 10.1097/MCG.0b013e3181cf8358]

- Vajro P, Lenta S, Socha P, Dhawan A, Mickiernan P, Baumann U. 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. [DOI: 10.1097/MPG.0b013e318252a13f]

- 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. [DOI: 10.1111/j.1572-0241.1999.01377.x]

- Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413-1419. [PMID: 10348825]

- Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, Ferrell LD, Liu YC, Torbenson MS, Unalp-Arida A, Yeh M, McCullough AJ, Sanyal AJ. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41: 1313–1321. [DOI: 10.1002/hep.20701]

- Bedossa P. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology 2012; 56: 1751-1759. [DOI: 10.1002/hep.25889]

- Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346: 1221-1231. [DOI: 10.1056/NEJMra011775]

- Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol H 2015; 13: 643-654. [DOI: 10.1016/j.cgh.2014.04.014]

- Kishida N, Matsuda S, Itano O, Shinoda M, Kitago M, Yagi H, Abe Y, Hibi T, Masugi Y, Aiura K, Sakamoto M, Kitagawa Y. Development of a novel mouse model of hepatocellular carcinoma with nonalcoholic steatohepatitis using a high-fat, cholinedeficient diet and intraperitoneal injection of diethylnitrosamine. BMC Gastroenterology 2016; 16:61. [DOI: 10.1186/s12876-016-0477-5]

- McPherson S, Hardy T, Henderson E, Burt AD, Day CP, Anstee QM. Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol 2015; 62: 1148-55. [DOI: 10.1016/j.jhep.2014.11.034]

- Auberval N, Dal S, Bietiger W, Pinget M, Jeandidier N, Maillard-Pedracini E, Schini-Kerth V, Sigrist S. Metabolic and oxidative stress markers in Wistar rats after 2 months on a high-fat diet. Diabetology & Metabolic Syndrome 2014; 6: 130. [DOI: 10.1186/1758-5996-6-130]

- Mohamed AA, Sabry S, Abdallah AM, Elazeem NAA, Refaey D, Algebaly HAF, Fath GAE, Omar H. Circulating adipokines in children with nonalcoholic fatty liver disease: possible noninvasive diagnostic markers. Annals of Gastroenterology 2017; 30: 457-463. [DOI: 10.20524/aog.2017.0148]

- Bedossa P. Pathology of non-alcoholic fatty liver disease. Liver Int 2017; 37: 85-89. [DOI: 10.1111/liv.13301]

- Zhang QZ, Liu YL, Wang YR, Fu LN, Zhang J, Wang XR, Wang BM. Effects of telmisartan on improving leptin resistance and inhibiting hepatic fibrosis in rats with non‑alcoholic fatty liver disease. Exp Ther Med 2017; 14: 2689-2694. [DOI: 10.3892/etm.2017.4809]

- Dowman JK, Hopkins LJ, Reynolds GM, Nikolaou N, Armstrong MJ, Shaw JC, Houlihan DD, Lalor PF, Tomlinson JW, Hübscher SG, Newsome PN. Development of Hepatocellular Carcinoma in a Murine Model of Nonalcoholic Steatohepatitis Induced by Use of a High-Fat/Fructose Diet and Sedentary Lifestyle. Am J Pathol 2014; 184: 1550-61. [DOI: 10.1016/j.ajpath.2014.01.034]

- Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980; 55: 434-8. [PMID: 7382552]

- Kleiner DE, Brunt EM. Nonalcoholic fatty liver disease: pathologic patterns and biopsy evaluation in clinical research. Semin Liver Dis 2012; 32: 3-13. [DOI: 10.1055/s-0032-1306421]

- Angulo P. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2015; 149: 389-393. [DOI: 10.1053/j.gastro.2015.04.043]

- Santiago-Rolón A. A Comparison of Brunt Criteria, the Non Alcoholic Fatty Liver Disease Activity Score (NAS) & a Proposed NAS-including fibrosis as Valid Diagnostic Scores for NASH. Puerto Rico health sciences journal 2015; 34: 189. [PMCID: PMC4720965]

Full Text: PDF HTML


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.