Natural history of nonalcoholic fatty liver disease: A prospective follow‐up study with serial biopsies

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world. The complete natural history of NAFLD is unknown because few high‐quality follow‐up studies have been conducted. Our aim was to find variables predicting disease severity through an extended follow‐up with serial biopsies. In a prospective cohort study, 129 patients who enrolled between 1988 and 1993 were asked to participate in a follow‐up study on two occasions; biochemical, clinical, and histologic data were documented. The mean time between biopsies was 13.7 (±1.7) and 9.3 (±1.0) years, respectively. At the end of the study period, 12 patients (9.3%) had developed end‐stage liver disease and 34% had advanced fibrosis. Out of the 113 patients with baseline low fibrosis (<3), 16% developed advanced fibrosis. Fibrosis progression did not differ among the different stages of baseline fibrosis (P = 0.374). Fifty‐six patients (43%) had isolated steatosis, of whom 9% developed advanced fibrosis (3 patients with biopsy‐proven fibrosis stage F3‐F4 and 2 patients with end‐stage liver disease). Fibrosis stage, ballooning, and diabetes were more common in patients who developed end‐stage liver disease; however, there were no baseline clinical, histologic, or biochemical variables that predicted clinical significant disease progression. Conclusion: NAFLD is a highly heterogeneous disease, and it is surprisingly hard to predict fibrosis progression. Given enough time, NAFLD seems to have a more dismal prognosis then previously reported, with 16% of patients with fibrosis stage <3 developing advanced fibrosis and 9.3% showing signs of end‐stage liver disease. (Hepatology Communications 2018;2:199–210)

Association between ADIPOQ G276T and C11377G polymorphisms and the risk of non‐alcoholic fatty liver disease: An updated meta‐analysis

“…The worldwide prevalence of NAFLD is on the rise, and it is rapidly becoming the most common cause of chronic liver disease affecting 25% of the world's population (Chalasani et al, 2018;Charlton et al, 2011;Townsend & Newsome, 2016). The characteristics of metabolic syndrome (Mets) are not only very common in NAFLD patients, but also the components of Mets increase the risk of NAFLD, such as existing etiology: obesity, Type 2 diabetes, hypertension, and dyslipidemia and emerging elements: sleep apnea, colorectal cancer, osteoporosis, psoriasis, endocrinopathies, and polycystic ovary syndrome (Nasr, Ignatova, Kechagias, & Ekstedt, 2018;Stefan, Kantartzis, & Haring, 2008). The pathogenesis of NAFLD is particularly complex, since it involves interactions between genetic and environmental factors, many of which have been indistinct (Heid et al, 2006).…”

Hepatocyte Deletion of Triglyceride‐Synthesis Enzyme Acyl CoA: Diacylglycerol Acyltransferase 2 Reduces Steatosis Without Increasing Inflammation or Fibrosis in Mice

“…(1) NAFLD/NASH can lead to complications such as fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. (2) There are no U.S. Food and Drug Administration (FDA)-approved medications to treat NAFLD, although multiple potential therapies are in phase III clinical trials. (3) Evidence suggests that treating NAFLD may be beneficial for preventing NASH and other sequalae.…”

CON: This Patient Should Have a Noninvasive Assessment of Liver Staging

“…NASH was noted to progress at a rate of 0.14 stage per year, equivalent to the progression by one stage of fibrosis every 7.1 years . Although a subset of patients will fall into the category of “rapid progressors,” meaning their disease will advance at a faster rate than the majority of patients with NASH, at present no histological or biochemical parameters have been able to identify the rapid progressors with reliability …”