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Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years.
Gut 2010; 59(7):969-74Gut

Abstract

BACKGROUND

Patients with non-alcoholic steatohepatitis (NASH) have increased mortality and liver-related complications. In contrast, simple steatosis is considered benign and non-progressive.

OBJECTIVE

To investigate disease progression in patients with different degrees of non-alcoholic fatty liver disease (NAFLD) activity.

DESIGN

Prospective longitudinal hospital-based cohort study.

PATIENTS

Fifty-two patients (age 44+/-9 years) with biopsy-proven NAFLD had liver biopsies repeated at month 36.

RESULTS

Among 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 alpha, 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).

CONCLUSIONS

Patients 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.

Authors+Show Affiliations

Department of Medicine and Therapeutics, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20581244

Citation

Wong, Vincent Wai-Sun, et al. "Disease Progression of Non-alcoholic Fatty Liver Disease: a Prospective Study With Paired Liver Biopsies at 3 Years." Gut, vol. 59, no. 7, 2010, pp. 969-74.
Wong VW, Wong GL, Choi PC, et al. Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut. 2010;59(7):969-74.
Wong, V. W., Wong, G. L., Choi, P. C., Chan, A. W., Li, M. K., Chan, H. Y., ... Chan, H. L. (2010). Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut, 59(7), pp. 969-74. doi:10.1136/gut.2009.205088.
Wong VW, et al. Disease Progression of Non-alcoholic Fatty Liver Disease: a Prospective Study With Paired Liver Biopsies at 3 Years. Gut. 2010;59(7):969-74. PubMed PMID: 20581244.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. AU - Wong,Vincent Wai-Sun, AU - Wong,Grace Lai-Hung, AU - Choi,Paul Cheung-Lung, AU - Chan,Anthony Wing-Hung, AU - Li,Mia Ka-Po, AU - Chan,Hoi-Yun, AU - Chim,Angel Mei-Ling, AU - Yu,Jun, AU - Sung,Joseph Jao-Yiu, AU - Chan,Henry Lik-Yuen, PY - 2010/6/29/entrez PY - 2010/6/29/pubmed PY - 2010/7/23/medline SP - 969 EP - 74 JF - Gut JO - Gut VL - 59 IS - 7 N2 - BACKGROUND: Patients with non-alcoholic steatohepatitis (NASH) have increased mortality and liver-related complications. In contrast, simple steatosis is considered benign and non-progressive. OBJECTIVE: To investigate disease progression in patients with different degrees of non-alcoholic fatty liver disease (NAFLD) activity. DESIGN: Prospective longitudinal hospital-based cohort study. PATIENTS: Fifty-two patients (age 44+/-9 years) with biopsy-proven NAFLD had liver biopsies repeated at month 36. RESULTS: Among 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 alpha, 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). CONCLUSIONS: Patients 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. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/20581244/Disease_progression_of_non_alcoholic_fatty_liver_disease:_a_prospective_study_with_paired_liver_biopsies_at_3_years_ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=20581244 DB - PRIME DP - Unbound Medicine ER -