SYSTEMATIC REVIEW article
Front. Endocrinol.
Sec. Translational and Clinical Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1652996
A New Perspective on Non-Invasive Diagnosis of Non-Alcoholic Fatty Liver Disease: Evidence Integration of Inflammatory and Metabolic Biomarkers Based on a Scoping Review
Provisionally accepted
- 1Tianjin Medical University, Tianjin, China
- 2Beijing Sunshine Lu-Tong Hospital of Traditional Chinese Medicine, Beijing, China
- 3Tianjin University Central Hospital, Tianjin, China
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Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver condition globally, spanning a spectrum from simple steatosis to non-alcoholic steatohepatitis (NASH) and progressive fibrosis. Inflammation and metabolic dysregulation play key roles in its pathogenesis. Accordingly, inflammatory and metabolic biomarkers have gained increasing attention as potential tools for noninvasive diagnosis and disease staging.This scoping review aimed to synthesize current evidence on the diagnostic performance of inflammatory and metabolic biomarkers for NAFLD, with a focus on their potential application in early screening and disease stratification.We systematically searched PubMed and CNKI databases for relevant peer-reviewed literature published up to August 2024. The search strategy combined MeSH terms and free-text keywords, and study selection was guided by the Population-Concept-Context (PCC) framework. Methodological quality was assessed using the Newcastle-Ottawa Scale and AHRQ criteria.Fifteen eligible studies (11 case-control, 2 cohort, 1 cross-sectional, and 1 retrospective study) were included, yielding 18 candidate biomarkers. The triglyceride-glucose (TyG) index was commonly associated with early-stage NAFLD screening; cytokeratin-18 (CK18) was linked to NASH detection, while adiponectin and osteopontin (OPN) were related to liver fibrosis. Additionally, inflammatory indices such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) showed clinical promise due to their accessibility and low cost.Inflammatory and metabolic biomarkers provide valuable non-invasive insights into the diagnosis and staging of NAFLD. The integration of multiple biomarkers may enhance diagnostic accuracy and support stratified management strategies. However, further validation is needed to establish standardized thresholds and confirm clinical utility across diverse populations.
Keywords: Non-alchoholic fatty liver disease, Inflammatory cyotokines, biomarkers, Non-invasive diagnosis, Scoping review
Received: 24 Jun 2025; Accepted: 12 Aug 2025.
Copyright: © 2025 LIANG, Zhang, Wei, Xi, Haize Ge and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huimin LIANG, Tianjin Medical University, Tianjin, China
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