title: Long-term prognosis of nonalcoholic fatty liver disease: is pharmacological therapy actually necessary?
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) comprises a wide spectrum of liver injury, ranging from steatosis and steatohepatitis to cirrhosis. Reasons for the different natural course in individuals with NAFLD are still unclear. The aim of this study was to describe the natural course of disease in individuals with NAFLD who did not receive pharmacological therapy.
  
  
  METHODS
  A total of 27 individuals with NAFLD (male/female ratio: 10/17, mean age 49.7 years) were prospectively enrolled. Management after diagnosis consisted of establishment of an appropriate diet and exercise (walking and jogging) program, treatment of associated metabolic conditions such as diabetes and dyslipidemia, and discontinuation of potentially hepatotoxic drugs if the patient was taking these. Liver tests were performed at diagnosis and at 3-month intervals during the follow-up period. Mean follow-up period was 43.3 months (range 36-49 months).
  
  
  RESULTS
  From baseline to the end of the follow-up period, although there was no significant difference observed in terms of the mean body mass index, serum aminotransferase levels significantly improved (48.8+/-29.9 U/L to 31.6+/-16.0 U/L for aspartate aminotransferase [AST] and 66.3+/-38.3 U/L to 39.6+/-22.9 U/L for alanine aminotransferase [ALT]; P<0.05). No significant differences in platelet counts, serum albumin level or prothrombin time were observed (P>0.05). No patient developed signs of advanced liver disease during the follow-up period.
  
  
  CONCLUSIONS
  A treatment strategy comprising diet, exercise and management of associated metabolic conditions is associated with improvement in aminotransferases among patients with NAFLD. Further investigation is needed to examine the long-term efficacy of this approach on liver histology and clinical outcomes.
authors.affiliation: Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey. cinar@medicine.ankara.edu.tr
authors.forename: Kubilay
authors.initials: K
authors.lastname: Cinar
authors.forename: Sahin
authors.initials: S
authors.lastname: Coban
authors.forename: Ramazan
authors.initials: R
authors.lastname: Idilman
authors.forename: Ali
authors.initials: A
authors.lastname: Tuzun
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sarioglu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Bektas
authors.forename: Esra
authors.initials: E
authors.lastname: Erden
authors.forename: Hakan
authors.initials: H
authors.lastname: Bozkaya
authors.forename: Ali
authors.initials: A
authors.lastname: Ozden
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D004035:Diet Therapy; D018450:Disease Progression; D005081:Exercise Therapy; D005234:Fatty Liver / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase