Evaluation of Progression of Hepatic Fibrosis in a Group of Patients With Non-Alcoholic Fatty Liver Disease Accompanied for 10 Years

Abstract

BACKGROUND: Non-alcoholic fatty liver disease has been progressively diagnosed in the general population as a consequence of the increased prevalence of obesity and type 2 diabetes mellitus, its main risk factors. It is characterized by accumulation of fat in the hepatocytes associated with lobular inflammation and balonization, which can lead to cirrhosis and hepatocarcinoma. Thus, a characterization and follow-up of a progression of the fibrosis level of these patients becomes important, being that the transient hepatic elastography is a reliable method for this evaluation with a measure of the kapa index. OBJECTIVE: To evaluate the progression of hepatic fibrosis through elastography in patients with non-alcoholic fatty liver disease. METHODS: Patients who had previously performed hepatic biopsy and noninvasive scores for non-alcoholic steatohepatitis (NASH) and fibrosis were included in the study. These same subjects were then submitted to current clinical evaluation, laboratory and liver elastography tests, defining the level of liver fibrosis, about 10 years after the first evaluation. RESULTS: Data were analyzed for 66 patients previously submitted to liver biopsy. Of these, 16 were not found, four could not participate because they were debilitated due to hepatic cirrhosis, two had died from an automobile accident and five from complications of cirrhosis of the liver. Therefore, of the 50 patients with a known history, 9 (18%) had died of cirrhosis or were unable to attend the examination because of their liver disease. The remaining population was predominantly female (61.5%), mean age of 63 years, being overweight, dyslipidemia (76.9%), disorders of the glycemic profile (76.9%), and metabolic syndrome (82.1%). Of the 39 cases evaluated, 35% had the same degree of fibrosis at the initial evaluation (biopsy) and at the current evaluation (elastography), 33% had an increase in the degree of fibrosis and another 30% had a decrease in the degree of fibrosis. Twenty-eight patients had NASH at baseline. Regarding these patients, it was observed in the current evaluation, that 25% remained stable in the degree of fibrosis, 39% progressed, and 35% regressed. CONCLUSION: Despite some limitations of our study, such as the small number of patients, and the use of two different methods of evaluation (biopsy and elastography), the data obtained allow us to conclude that of the 39 evaluated cases, 33% (13) presented progression of fibrosis and the total group of 50 patients, 42% had cirrhosis or died due to liver disease. The presence of NASH on hepatic biopsy did not prove to be, in our study, a predictive of the evolution of hepatic fibrosis in the patients.

Risk Predictors of Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease

“…In this regard, insulin resistance is currently considered to be a major mechanism in the development and evolution of non-alcoholic fatty liver disease towards steatohepatitis and advanced fibrosis [ 18 , 19 ]. In support of this hypothesis, there are also a number of results reported in the literature that show that the prevalence of non-alcoholic fatty liver disease can reach up to 80% in diabetic patients and advanced fibrosis is identified in a higher percentage in diabetic patients than in patients without diabetes [ 16 , 17 , 20 , 21 ].…”

“…Another risk factor involved in the development and progression of NAFLD is age, with advanced fibrosis being significantly more common in older patients [ 1 ]. A number of studies that have analyzed groups of patients with non-alcoholic fatty liver disease reported a mean age between 51 years [ 16 ] and 63 years [ 17 ]. The mean age of patients with non-alcoholic fatty liver disease in our study was 53.56 years, which is within the range of values presented by the literature data.…”

“…In the studied group, glycemia (G) values were directly proportionally correlated with elastometric values. In most studies in the literature, diabetes mellitus is considered an important risk factor for hepatic steatosis, advanced fibrosis, and cirrhosis [ 17 , 20 , 29 ].…”

Nonalcoholic Fatty Liver Disease (Nafld), More Than a Liver Disease

“…Although NASH was the former histological feature to be related with survival, further studies showed that fibrosis (especially advanced or significant fibrosis) was more associated with increment in death from liver disease and also from non-hepatic causes than the necroinflammatory component (22)(23)(24) . Such observations, highlights the importance of studies on the natural history of the disease and its progression toward liver fibrosis, as observed in the article from Castro et al in this issue of Arq Gastroenterol (25) .…”

Relation of Dietary Patterns and Nutritional Profile to Hepatic Fibrosis in a Sample of Lebanese Non-Alcoholic Fatty Liver Disease Patients

“…Regarding liver fibrosis, no significant differences in clinical and environmental parameters were found between the two NFS score groups, except for the age and the presence of obesity, diabetes type 2, cardiovascular diseases (CVD), and the ratio of ASAT to ALAT. These parameters were found to be associated with the presence of hepatic fibrosis [33], and the ASAT/ALAT ratio could be used as a screening tool for liver evaluation and detection of advanced liver fibrosis [34]. Their increase is related to the presence of free inflammatory fatty acids, which contribute to a state of insulin resistance, hence increasing the degree of severity of non-alcoholic steatosis (Table 3) [35].…”