title: Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity.
abstract: OBJECTIVE
  The spectrum of nonalcoholic fatty liver disease ranges from fatty liver alone to nonalcoholic steatohepatitis. Most previous studies have short follow-up and have not carefully delineated different histological types when determining clinical outcomes. The aim of this study was to compare clinical characteristics and outcomes of patients with different types of nonalcoholic fatty liver.
  
  
  METHODS
  All liver biopsy specimens from 1979 to 1987 with fat accumulation were assessed for inflammation, ballooning degeneration, Mallory hyaline, and fibrosis. Biopsy specimens were also assessed for histological iron and hepatitis C RNA. Outcomes were cirrhosis, mortality, and liver-related mortality.
  
  
  RESULTS
  Of 772 liver biopsy specimens, complete data were available in 132 patients. Fatty liver (type 1) did not differ from the other three types combined with respect to gender, race, age, or obesity. Cirrhosis was more common in the other types combined (22%) than fatty liver alone (4%; P </= 0.001). Overall mortality, histological iron, and hepatitis C did not differ between groups. Most of the liver-related deaths were in type 4.
  
  
  CONCLUSIONS
  The outcome of cirrhosis and liver-related death is not uniform across the spectrum of nonalcoholic fatty liver. These poor outcomes are more frequent in patients in whom biopsies show ballooning degeneration and Mallory hyaline or fibrosis.
authors.affiliation: Department of Gastroenterology, Cleveland, Ohio, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Matteoni
authors.forename: Z M
authors.initials: ZM
authors.lastname: Younossi
authors.forename: T
authors.initials: T
authors.lastname: Gramlich
authors.forename: N
authors.initials: N
authors.lastname: Boparai
authors.forename: Y C
authors.initials: YC
authors.lastname: Liu
authors.forename: A J
authors.initials: AJ
authors.lastname: McCullough
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005234:Fatty Liver / Q000145:classification / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006801:Humans; D007501:Iron / Q000378:metabolism; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012333:RNA, Messenger / Q000378:metabolism; D012367:RNA, Viral / Q000378:metabolism; D016019:Survival Analysis
chemical_list: D012333:RNA, Messenger; D012367:RNA, Viral; D007501:Iron