Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years
- Vincent Wai-Sun Wong1,2,
- Grace Lai-Hung Wong1,2,
- Paul Cheung-Lung Choi3,
- Anthony Wing-Hung Chan3,
- Mia Ka-Po Li1,2,
- Hoi-Yun Chan1,2,
- Angel Mei-Ling Chim1,2,
- Jun Yu1,2,
- Joseph Jao-Yiu Sung1,2,
- Henry Lik-Yuen Chan1,2
- 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong
- 2Institute of Digestive Disease, The Chinese University of Hong Kong
- 3Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong
- Correspondence to Professor Henry L-Y Chan, Department of Medicine and Therapeutics, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong; hlychan{at}cuhk.edu.hk
- Revised 25 March 2010
- Accepted 26 March 2010
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 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).
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.
Footnotes
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Funding The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Competing interests None.
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Ethics approval This study was conducted with the approval of the Chinese University Clinical Research Ethics Committee.
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Provenance and peer review Not commissioned; externally peer reviewed.
