Clinical guidelines of non-alcoholic fatty liver disease: A systematic review.
OBJECTIVE
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.


CONCLUSIONS
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.
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.
Jin-Zhou
JZ
Zhu
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
K
Hollis-Hansen
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.
Xing-Yong
XY
Wan
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.
Su-Juan
SJ
Fei
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.
Xun-Lei
XL
Pang
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.
Fan-Dong
FD
Meng
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.
Chao-Hui
CH
Yu
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.
You-Ming
YM
Li
D000465:Algorithms; D019317:Evidence-Based Medicine; D005762:Gastroenterology / Q000379:methods / Q000592:standards; D006801:Humans; D007391:International Cooperation; D065626:Non-alcoholic Fatty Liver Disease / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
Diagnosis; Management; Non-alcoholic fatty liver disease; Systematic review; Treatment
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