Original article—liver, pancreas, and biliary tract
Long-Term Follow-Up of Patients With Nonalcoholic Fatty Liver

https://doi.org/10.1016/j.cgh.2008.11.005Get rights and content

Background & Aims

Nonalcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of conditions ranging from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH) convincingly. NASH is the only subtype of NAFLD that has been shown to progress relatively, although these findings were reported from studies with short follow-up periods. We assessed the long-term outcomes of a NAFLD cohort.

Methods

Patients with NAFLD established by biopsy were identified in databases and categorized as NASH or non-NASH. Mortality data and causes of death were obtained from National Death Index Plus. The nonparametric Kaplan–Meier method with log-rank test and multivariate analyses with a Cox proportional hazard model were used to compare different NAFLD subtypes and to identify independent predictors of overall and liver-related mortality.

Results

Of 173 NAFLD patients (age at biopsy, 50.2 ± 14.5 y; 39.9% male; 80.8% Caucasian; 28.9% with type II diabetes), 72 (41.6%) had NASH and 101 (58.4%) had non-NASH NAFLD. Over the follow-up period, the most common causes of death were coronary artery disease, malignancy, and liver-related death. Although overall mortality did not differ between the NAFLD subtypes, liver-related mortality was higher in patients with NASH (P < .05). Independent predictors of liver-related mortality included histologic NASH, type II diabetes, older age at biopsy, lower albumin levels, and increased levels of alkaline phosphatase (P < .05).

Conclusions

This long-term follow-up evaluation of NAFLD patients confirms that NASH patients have increased liver-related mortality compared with non-NASH patients. In addition, patients with NAFLD and type II diabetes are especially at risk for liver-related mortality.

Section snippets

Patient Population

Data on patients with histologically proven NAFLD were obtained from our fatty liver databases. These databases included our previously reported cohort from the Cleveland Clinic Foundation (CCF),1 as well as patients with biopsy-proven NAFLD from the Center for Liver Diseases (CLD). To be included in the study, a patient must have had biopsy-proven NAFLD with a minimum of 5 years of follow-up. Patients were excluded for the following reasons: (1) daily alcohol intake greater than 20 g in men

Results

A total of 173 NAFLD patients met the criteria for inclusion in the study. Of these, 131 NAFLD patients were available from a previously reported CCF cohort and 42 were from the CLD cohort.

Demographic data of the entire cohort revealed that 39.9% were male, 80.8% were Caucasian, 13.9% were African American, and 1.2% were Hispanic. Type 2 diabetes mellitus was present in 28.8% of the cohort. The average age at the time of biopsy was 50.2 ± 14.5 years. Histologic data revealed that 72 patients

Discussion

The prevalence of NAFLD is expected to increase with the increase in obesity and metabolic syndrome. Several studies have potentially shown that only the NASH subtype of NAFLD can progress.1, 15, 16, 17, 18, 19, 21 This progression may occur slowly over the course of decades. The risk of progression seems to be associated with complications of metabolic syndrome such as a higher BMI, greater insulin resistance, or the presence of clinically overt type 2 diabetes.16, 17 Furthermore, recent

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    The authors disclose no conflicts.

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    Copyright © 2009 AGA Institute. Published by Elsevier Ltd. All rights reserved.