Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years.
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.


METHODS
Prospective longitudinal hospital-based cohort study.


METHODS
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 alpha, 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.
Wong
Vincent Wai-Sun
VW
Department of Medicine and Therapeutics, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
Wong
Grace Lai-Hung
GL
Choi
Paul Cheung-Lung
PC
Chan
Anthony Wing-Hung
AW
Li
Mia Ka-Po
MK
Chan
Hoi-Yun
HY
Chim
Angel Mei-Ling
AM
Yu
Jun
J
Sung
Joseph Jao-Yiu
JJ
Chan
Henry Lik-Yuen
HL
D000328:Adult; D000368:Aged; D000886:Anthropometry / Q000379:methods; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015992:Body Mass Index; D018450:Disease Progression; D004812:Epidemiologic Methods; D005234:Fatty Liver / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055105:Waist Circumference; D015431:Weight Loss; D055815:Young Adult
D015415:Biomarkers