Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases characterized by fatty accumulation in hepatocytes, ranging from steatosis, non-alcoholic steatohepatitis, to cirrhosis. While histopathological evaluation of liver biopsies plays a central role in the diagnosis of NAFLD, limitations such as the problem of interobserver variability still exist and active research is underway to improve the diagnostic utility of liver biopsies. In this article, we provide a comprehensive overview of the histopathological features of NAFLD, the current grading and staging systems, and discuss the present and future roles of liver biopsies in the diagnosis and prognostication of NAFLD.
Citations
Citations to this article as recorded by
A new diphenylmethanone from
Rumex crispus
L. ameliorates sodium palmitate-oleate induced steatosis in HepG2 cells
Wen-Yao Zou, Zheng-Hong Guo, Shuai Dou, Ting Xiao, Wu-de Yang Natural Product Research.2026; 40(13): 3936. CrossRef
An electroneutral fluorescent probe for visualization of lipid droplets polarity heterogeneity and NAFLD detection Zhengshuai Wu, Fei Gao, Shuyu Wang, Mengqi Yan, Shuxian Cao, Junjun Liu, Xinyue Li, Guoxia Liu, Sumei Lu, Xuechen Li Spectrochimica Acta Part A: Molecular and Biomolecular Spectroscopy.2026; 346: 126842. CrossRef
Clinical Profile of Psoriasis Patients With Comorbid Fatty Liver and Risk Factors for Advanced Liver Fibrosis in Those With Metabolic Dysfunction–Associated Steatotic Liver Disease Hidenori Watabe, Tomomitsu Miyagaki, Kaori Nakajima, Ken Go, Tatsuro Okano, Takafumi Kadono The Journal of Dermatology.2026; 53(2): 237. CrossRef
Effects of pemafibrate on liver fibrosis in patients with MASLD and hypertriglyceridemia: A 2-year retrospective observational study using MR elastography Hidenao Noritake, Takafumi Inoue, Takashi Yonekura, Hiroki Tamakoshi, Yuya Ida, Moe Matsumoto, Tomohiko Hanaoka, Maho Yamashita, Masahiro Umemura, Kazuyoshi Ohta, Takeshi Chida, Kazuhito Kawata Journal of Clinical Lipidology.2026; 20(5): 947. CrossRef
Expression of caspase-8 in non-alcoholic fatty liver disease related to ligature-induced periodontitis in rats Felipe Rodolfo Pereira da Silva, Victor Brito Dantas Martins, Hélio Mateus Silva Nascimento, Paulo Roberto Carneiro Gomes, Nikaely Brandão Barbosa, Vinícius da Silva Caetano, Ivana Márcia Alves Diniz, Karine Duarte da Silva, Any Carolina Cardoso Guimarães Journal of Applied Oral Science.2026;[Epub] CrossRef
Advances in Diagnostic and Therapeutic Strategies for Metabolic Dysfunction-Associated Steatotic Liver Disease Ryan Njeim, Omar Abureesh, Ali Sohail, Ryan Tam, Liliane Deeb Livers.2026; 6(3): 35. CrossRef
Spatial hepatology: Decoding liver zonation for metabolic and regenerative therapeutics (Review) Guiqing Chen, Hongyan Jia, Kai Zhao, Chang Gao, Yue Liu, Hong Zhu, Dakai Yang, Yun Cai International Journal of Molecular Medicine.2026; 58(1): 1. CrossRef
Alpha‑lipoic acid–loaded chitosan nanoparticles ameliorate streptozotocin‑induced diabetic liver injury via Nrf2/HO‑1 activation and TLR4/NF‑κB and JAK2/STAT1 inhibition Hussein Abdelaziz Abdalla, Ekramy M. Elmorsy, Najlaa M. M. Jawad, Nora Hosny, Ahmed S. Shams, Rawan Ahmed Ayaz, Manal S. Fawzy, Gehad E. Elshopakey Naunyn-Schmiedeberg's Archives of Pharmacology.2026; 399(11): 18061. CrossRef
Dapansutrile mitigates methotrexate-induced hepatotoxicity in rats: roles of inflammation, oxidative stress, pyroptosis, and autophagy Haider H. Motlak, Mahmoud Elshal, Marwa S. Serrya Frontiers in Pharmacology.2026;[Epub] CrossRef
Glucosamine Promotes Autophagy and Attenuates Hepatic Steatosis Via O‐GlcNAcylation–Mediated Mechanisms Jiwon Park, Dong Yeol Kim, Quynh T. N. Nguyen, Inn‐Oc Han Journal of Biochemical and Molecular Toxicology.2026;[Epub] CrossRef
Association of the atherogenic index of plasma and derived indicators with future risk of liver diseases and alcoholic liver disease among Chinese middle-aged and elderly adults: A nationwide cohort study Meng Chen, Changhong Sun, Tie-Jun Li Medicine.2026; 105(32): e50030. CrossRef
Integrative multi-omics and machine learning identify the SPI1-METTL16-PLIN4 axis as a candidate driver of steatosis in HepG2 cells Zhizhou Xiao, Huawei Bian, Ying Huang Biochemical and Biophysical Research Communications.2026; 834: 154435. CrossRef
Spatial immune niche remodeling of the neutrophil-macrophage axis inchronic liver disease Jian Ding, Xiang Xiong, Changming Zhang, Hongcai Fang, Shu Li Frontiers in Cell and Developmental Biology.2026;[Epub] CrossRef
From Molecular Mechanisms to Clinical Strategies: A Comprehensive Overview of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Damian Świerczek, Maja Dreger, Jakub Jatkowski, Jakub Kancerek, Bogna Drozdzowska, Romuald Wojnicz International Journal of Molecular Sciences.2026; 27(17): 7825. CrossRef
MiR-625-5p regulates the development of non-alcoholic fatty liver disease by targeting CCND1 Menghua Fan, Shurui Xie, Rongfang Zhai Turkish Journal of Biochemistry.2026;[Epub] CrossRef
Liver Cancer Risk Across Metabolic Dysfunction-Associated Steatotic Liver Disease and/or Alcohol: A Nationwide Study Byungyoon Yun, Heejoo Park, Sang Hoon Ahn, Juyeon Oh, Beom Kyung Kim, Jin-Ha Yoon American Journal of Gastroenterology.2025; 120(2): 410. CrossRef
Female C57BL/6 mice exhibit protection against nonalcoholic fatty liver disease and diabesity accompanied by differential regulation of hepatic lipocalin prostaglandin D2 synthase Md Asrarul Islam, Rhema Khairnar, Joshua Fleishman, Sandra E. Reznik, Louis Ragolia, Shruthi Gobbooru, Sunil Kumar Molecular and Cellular Endocrinology.2025; 595: 112404. CrossRef
Extracellular vesicle-mediated approaches for the diagnosis and therapy of MASLD: current advances and future prospective Swasthika Gurjar, Ramanarayana Bhat A, Raghavendra Upadhya, Revathi P. Shenoy Lipids in Health and Disease.2025;[Epub] CrossRef
Do Child–Turcotte–Pugh and nutritional assessments predict survival in cirrhosis: A longitudinal study Randhall B Carteri, Claudio A Marroni, Luis F Ferreira, Letícia P Pinto, Juliana Czermainski, Cristiane V Tovo, Sabrina A Fernandes World Journal of Hepatology.2025;[Epub] CrossRef
Unraveling the molecular mechanisms of Fufangduzhong formula in alleviating high-fat diet-induced non-alcoholic fatty liver disease in mice Yu Mou, Yao Tang, Xiuyan Zheng, Xiang Liu, Xuemei Wu, Hongji Wang, Jie Zeng, Qing Rao, Yaacov Ben-David, Yanmei Li, Lei Huang Frontiers in Pharmacology.2025;[Epub] CrossRef
Elevated red blood cell folate levels are associated with metabolic dysfunction-associated steatotic liver disease: results from NHANES 2017–2020 Xin Liao, Song Yu, Lin Wang, Ruyue Zhang, Ke Yu Frontiers in Physiology.2025;[Epub] CrossRef
Investigating the Effects of Gossypetin on Liver Health in Diet-Induced Pre-Diabetic Male Sprague Dawley Rats Karishma Naidoo, Andile Khathi Molecules.2025; 30(8): 1834. CrossRef
Prospective Comparison of 2D-Shear Wave Elastography and Vibration-Controlled Transient Elastography in Assessing Liver Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease Qingxin Li, Yanhang Gao, Dongxuan Wang, Xiaoxue Zhu, Jing Jia, Lili Liu, Huining Tian, Lishuang Wang, Yingwen Zhang, Dezhi Zhang Academic Radiology.2025; 32(9): 5100. CrossRef
Alisol B alleviates MASLD by activating liver autophagy and fatty acid oxidation via Ces2a Congcong Zhang, Lin Chen, Yuwei Jiang, Jiannan Qiu, Yiyou Lin, Guilin Ren, Fangying Xu, Jiale Xi, Zhiling Yu, Xianglu Rong, Xiaobing Dou International Immunopharmacology.2025; 157: 114768. CrossRef
Multiple machine learning algorithms identify 13 types of cell death-critical genes in large and multiple non-alcoholic steatohepatitis cohorts Renao Jiang, Longfei Dai, Xinjian Xu, Zhen Zhang Lipids in Health and Disease.2025;[Epub] CrossRef
Therapeutic potential of Glycyrrhiza glabra L. extract and atorvastatin in HFD-induced MAFLD: in vitro and in vivo exploration Saumya Rastogi, Vishwajeet Bachhar, Vibha Joshi, Sanjay Kumar, Dharamveer Panjwani, Lakhveer Singh, Rajesh Haldhar 3 Biotech.2025;[Epub] CrossRef
Efficacy of interventions with live combined Bacillus subtilis and Enterococcus faecium enteric-coated capsules in metabolic associated fatty liver disease patients: a meta-analysis of randomized controlled trials Yutong Wu, Hao Wu, Hang Yi Frontiers in Pharmacology.2025;[Epub] CrossRef
Deep learning-based method for grading histopathological liver fibrosis in rodent models of metabolic dysfunction-associated steatohepatitis Soo Min Ko, Jae-ik Shin, Yiyu Hong, Hyunji Kim, Insuk Sohn, Ji-Young Lee, Hyo-Jeong Han, Da Som Jeong, Yerin Lee, Woo-Chan Son Frontiers in Medicine.2025;[Epub] CrossRef
КЛІНІКО-МОРФОЛОГІЧНІ АСПЕКТИ ПЕРВИННОГО НЕАЛКОГОЛЬНОГО СТЕАТОГЕПАТИТУ ЗА НАЯВНОСТІ КОМОРБІДНОЇ ПАТОЛОГІЇ ЖОВЧНОГО МІХУРА О. Ю. Фофанова, В. В. Феденько, З. Я. Гурик, Е. О. Кіндратів, І. Г. Лаб'як Art of Medicine.2025; : 113. CrossRef
Calycosin-7-O-β-D-glucoside alleviates nonalcoholic fatty liver disease by regulating short-chain fatty acids metabolism and metabolic regulators Yanping Zeng, Xinrun Huang, Yuci Ma, Xiaodie Di, Zhao Li, Hebin Wang, Xiaodong Wei The Journal of Nutritional Biochemistry.2025; 145: 110018. CrossRef
Assessing Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Patients at a Tertiary Hospital, Addis Ababa, Ethiopia Edomias Adyamseged Berhe, Rediet Ambachew Sema, Yididya Mehari Tesfaye, Abel Andargie Berhane, Mikale Dawit, Ephrem Mamo Gebrehiwot, Subah Abderehim Yesuf, Balamurugan Ramatchandirin Journal of Diabetes Research.2025;[Epub] CrossRef
Automated Detection of Non‐Alcoholic Fatty Liver Disease Using Histopathological Images: A Systematic Review Hamed Zamanian, Ahmad Shalbaf, Maryam Parvizi, Roohallah Alizadehsani, Ru‐San Tan, U. Rajendra Acharya WIREs Data Mining and Knowledge Discovery.2025;[Epub] CrossRef
Polarity Prompting Vision Foundation Models for Pathology Image Analysis Chong Yin, Siqi Liu, Kaiyang Zhou, Vincent Wai-Sun Wong, Pong C. Yuen IEEE Transactions on Medical Imaging.2025; 44(11): 4579. CrossRef
Matcha mitigates metabolic and inflammatory disturbances induced by high-fat-sucrose diets in rats Nourhan M. Abd El-Aziz, Marwa R. Elbakatoshy, Ebtehal A. Farrage, Oscar Zannou, Reza Tahergorabi, Ayman M. Khalifah, Majid Aminzare, Mohamed G. Shehata Journal of Functional Foods.2025; 135: 107112. CrossRef
Metabolic Dysfunction-Associated Steatohepatitis in Focus: Pathogenesis, Non-Invasive Diagnostics, and Future Approaches Abdulrahman Ismaiel, Mhd Bashir Almonajjed, Cristina Sorina Catana, Stefan-Lucian Popa, Dan L. Dumitrascu Archives of Medical Research.2025; 56(8): 103350. CrossRef
Occupational and lifestyle risk factors associated with metabolic fatty liver disease among university staff in Indonesia Mutmainnah Husaema, Lalu Muhammad Saleh, Muhammad Furqaan Naiem, Atjo Wahyu, Darmawansyah D Frontiers in Public Health.2025;[Epub] CrossRef
STEATOTIC LIVER DISEASE: THE IMPACT OF TEA AND COFFEE CONSUMPTION. LITERATURE REVIEW
V.S. Rakhmetova Наука и здравоохранение.2025; (5(27)): 261. CrossRef
Association of Stroke With Metabolic Dysfunction–Associated Fatty Liver Disease With and Without CKD Yuhao Li, Shouling Wu, Jingli Gao, Yijun Zhang, Yingting Zuo, Xue Tian, Shuohua Chen, Aijun Xing, Anxin Wang, Yan He American Journal of Kidney Diseases.2024; 83(4): 477. CrossRef
Sex-specific differences in ectopic fat and metabolic characteristics of paediatric nonalcoholic fatty liver disease Eun Hye Lee, Ji Young Kim, Hye Ran Yang International Journal of Obesity.2024; 48(4): 486. CrossRef
Research progress, challenges and perspectives of phospholipids metabolism in the LXR‑LPCAT3 signaling pathway and its relation to NAFLD (Review) Junmin Wang, Jiacheng Li, Yugang Fu, Yingying Zhu, Liubing Lin, Yong Li International Journal of Molecular Medicine.2024;[Epub] CrossRef
Proposal of a Novel Serological Algorithm Combining FIB-4 and Serum M2BPGi for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease Sang Yi Moon, Yang Hyun Baek, Se Young Jang, Dae Won Jun, Ki Tae Yoon, Young Youn Cho, Hoon Gil Jo, Ae Jeong Jo Gut and Liver.2024; 18(2): 283. CrossRef
Lipid droplet detection in histopathological images using reinforcement learning Yoshitomi Harada, Haruto Nishida, Keiko Matsuura Biotechnology & Biotechnological Equipment.2024;[Epub] CrossRef
Evaluating the relative importance of different blood pressure indices in screening for NAFLD: a survey report based on a health examination population Chong Hu, Ziqi Yu, Changli Wei, Guotai Sheng, Jianyong Chen, Yang Zou Frontiers in Cardiovascular Medicine.2024;[Epub] CrossRef
Perilipins: A family of five fat‐droplet storing proteins that play a significant role in fat homeostasis Preethi Chandrasekaran, Sabine Weiskirchen, Ralf Weiskirchen Journal of Cellular Biochemistry.2024;[Epub] CrossRef
A preclinical model of severe NASH-like liver injury by chronic administration of a high-fat and high-sucrose diet in mice Rose A. Willett, Volodymyr P. Tryndyak, Jennifer M. Hughes Hanks, Lana Elkins, Suresh K. Nagumalli, Mark I. Avigan, Sharon A. Ross, Gonçalo Gamboa da Costa, Frederick A. Beland, Ivan Rusyn, Igor P. Pogribny Toxicology and Applied Pharmacology.2024; 491: 117046. CrossRef
A peptide alleviated oxidative damages in the L02 cells and mice liver Gan Gao, Zhiyang Zhang, Qiheng Wang, Zhihui Xie, Bing Liu, Hongliang Huang Biochemical and Biophysical Research Communications.2024; 734: 150643. CrossRef
Targeting long non-coding RNA H19 as a therapeutic strategy for liver disease Yulan Shi, Fenghua Qu, Shiyun Zeng, Xinchen Wang, Yuting Liu, Qirui Zhang, Ding Yuan, Chengfu Yuan Progress in Biophysics and Molecular Biology.2024; 194: 1. CrossRef
Transcription factor ETV4 plays a critical role in the development of non-alcoholic fatty liver disease Bhavani Gadiraju, Jhansi Magisetty, Vijay Kondreddy International Journal of Biological Macromolecules.2024; 282: 137235. CrossRef
Arctium lappa L. Extract Alleviates Non-Alcoholic Fatty Liver Injury in Mices 娜 李 Hans Journal of Medicinal Chemistry.2024; 12(04): 309. CrossRef
Metabolic Dysfunction-Associated Steatotic Liver Disease in Type 2 Diabetes Mellitus: A Review and Position Statement of the Fatty Liver Research Group of the Korean Diabetes Association Jaehyun Bae, Eugene Han, Hye Won Lee, Cheol-Young Park, Choon Hee Chung, Dae Ho Lee, Eun-Hee Cho, Eun-Jung Rhee, Ji Hee Yu, Ji Hyun Park, Ji-Cheol Bae, Jung Hwan Park, Kyung Mook Choi, Kyung-Soo Kim, Mi Hae Seo, Minyoung Lee, Nan-Hee Kim, So Hun Kim, Won- Diabetes & Metabolism Journal.2024; 48(6): 1015. CrossRef
Evaluation of autoimmune phenomena in patients with nonalcoholic fatty liver disease on the basis of liver pathology Yu-Jin Zhu, Yan Zhang, Yao Rao, Yong Jiang, Yong-Gang Liu, Jian-Zhou Li, Jia-Qi Yuan, Ying Zhao, Wen-Wen Zheng, Lin Ma, Chun-Yan Wang, Jia Li World Journal of Hepatology.2024; 16(12): 1407. CrossRef
Gut microbiome and nonalcoholic fatty liver disease Meng-Yuan Wu, Jian-Gao Fan Hepatobiliary & Pancreatic Diseases International.2023; 22(5): 444. CrossRef