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Natural History of Nonalcoholic Fatty Liver Disease

NASH does progress to cirrhosis, but only in a minority of cases.

Although nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver disorders, its natural history has been unclear. In this cohort study from Sweden, investigators describe the long-term outcome of patients with biopsy-proven NAFLD.

In 212 consecutive patients who were referred from 1988 through 1993 for work-up of chronically elevated liver enzymes, 129 were diagnosed with biopsy-proven NAFLD. Thorough baseline information was available through a national registry. Survival and causes of death in these patients were compared with the same outcomes in an age- and sex-matched Swedish reference population.

The mean follow-up was 13.7 years (±1.3 years) from the time of NAFLD diagnosis. At baseline, 71 (55%) patients had nonalcoholic steatohepatitis (NASH), including 4 (3%) with cirrhosis; 46 (36%) had simple steatosis; and 12 (9%) had steatosis with unspecific inflammation. Survival rates were significantly lower in the NASH group than in the reference population (70% vs. 80%; P=0.01), but no survival difference was found between the reference population and the steatosis groups combined. A significantly larger percentage of NASH patients than reference-group subjects died of liver disease (2.8% vs. 0.2%; P=0.04). Seven NASH patients, but none of the steatosis patients, developed cirrhosis during follow-up.

Comment: Results of this important study show that a proportion of patients with NASH progressed to cirrhosis (8.5% during 13 years) and that NASH patients had lower survival rates and higher rates of liver-related mortality than did the general population. However, patients with steatosis did not develop progressive liver disease. Patients with NASH should be counseled about the progressive nature of their disease. They should be encouraged to lose weight, and any conditions that increase risk should be treated.

— Atif Zaman, MD, MPH

Published in Journal Watch Gastroenterology January 19, 2007

Citation(s):

Ekstedt M et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology 2006 Oct; 44:865-73.

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