Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years

• Published in: Gut Vol. 59; no. 7; pp. 969 - 974
• Main Authors: Wong, Vincent Wai-Sun, Wong, Grace Lai-Hung, Choi, Paul Cheung-Lung, Chan, Anthony Wing-Hung, Li, Mia Ka-Po, Chan, Hoi-Yun, Chim, Angel Mei-Ling, Yu, Jun, Sung, Joseph Jao-Yiu, Chan, Henry Lik-Yuen
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.07.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Accuracy; Adult; Aged; Anthropometry - methods; Biological and medical sciences; Biomarkers - blood; Biopsy; Body Mass Index; Cytokines; Digestive system; Disease Progression; Epidemiologic Methods; Exercise; Fatty Liver - diagnosis; Fatty Liver - pathology; Female; Gangrene; Gastroenterology. Liver. Pancreas. Abdomen; Glucose; Hepatitis; Humans; Insulin; Insulin resistance; Investigative techniques, diagnostic techniques (general aspects); Lifestyles; Liver - pathology; Liver cirrhosis; Liver diseases; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Metabolism; Middle Aged; Mortality; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Physical fitness; Prognosis; Studies; Tumor necrosis factor-TNF; Waist Circumference; Weight Loss; Womens health; Young Adult; Liver biopsy; Prognosis; Non alcoholic steatohepatitis; Gastroenterology; Digestive diseases; Hepatic disease; Evolution
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gut.2009.205088

BackgroundPatients with non-alcoholic steatohepatitis (NASH) have increased mortality and liver-related complications. In contrast, simple steatosis is considered benign and non-progressive.ObjectiveTo investigate disease progression in patients with different degrees of non-alcoholic fatty liver disease (NAFLD) activity.DesignProspective longitudinal hospital-based cohort study.PatientsFifty-two patients (age 44±9 years) with biopsy-proven NAFLD had liver biopsies repeated at month 36.ResultsAmong 13 patients with simple steatosis at baseline, 2 (15%) had a normal liver at month 36, 3 (23%) continued to have simple steatosis, 5 (39%) developed borderline NASH and 3 (23%) developed NASH. Among 22 patients with borderline NASH at baseline, 4 (18%) had simple steatosis and 13 (59%) had borderline NASH at month 36, while 5 (23%) developed NASH. Among 17 patients with NASH at baseline, 10 (59%) continued to have NASH and 6 (35%) had borderline NASH at month 36. Only 1 (6%) patient regressed to simple steatosis. Overall, 14 (27%) patients had fibrosis progression, 25 (48%) had static disease, and 13 (25%) had fibrosis regression. Reduction in body mass index and waist circumference was independently associated with non-progressive disease activity and fibrosis. The baseline serum levels and month 36 changes in adiponectin, tumour necrosis factor α, interleukin 6 and leptin were not associated with disease progression. Serum cytokeratin-18 fragment level reflected disease activity and its change correlated with the change in NAFLD activity score (R=0.51, p<0.001).ConclusionsPatients with simple steatosis may still develop NASH and fibrosis progression. Weight reduction is associated with non-progressive disease. All patients with NAFLD should undergo periodic assessment and lifestyle modification.