title: Long-term follow-up of patients with nonalcoholic fatty liver.
abstract: OBJECTIVE
  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.
authors.affiliation: Center for Liver Diseases, Inova Health System, Annandale, Virginia, USA.
authors.forename: Nila
authors.initials: N
authors.lastname: Rafiq
authors.forename: Chunhong
authors.initials: C
authors.lastname: Bai
authors.forename: Yun
authors.initials: Y
authors.lastname: Fang
authors.forename: Manirath
authors.initials: M
authors.lastname: Srishord
authors.forename: Arthur
authors.initials: A
authors.lastname: McCullough
authors.forename: Terry
authors.initials: T
authors.lastname: Gramlich
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors