Clinical course of nonalcoholic fatty liver disease: an assessment of severity, progression, and outcomes

Abstract

PurposeTo identify the characteristics and initial disease severity of patients with nonalcoholic fatty liver disease (NAFLD) and assess incidence and risk factors for disease progression in a retrospective study.MethodsPatients ≥18 years of age without alcoholism or other liver diseases (eg, hepatitis B/C) were selected from Geisinger Health System electronic medical record data from 2004 to 2015. Initial disease stage was stratified into uncomplicated NAFLD, advanced fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and liver transplant using clinical biomarkers, diagnosis, and procedure codes. Disease progression was defined as stage progression or death and analyzed via Kaplan–Meier plots and multistate models.ResultsIn the NAFLD cohort (N=18,754), 61.5% were women, 39.0% had type 2 diabetes mellitus (T2DM), and the mean body mass index was 38.2±10.2 kg/m2. At index, 69.9% had uncomplicated NAFLD, 11.7% had advanced fibrosis, and 17.8% had cirrhosis. Of 18,718 patients assessed for progression, 17.3% progressed (11.0% had stage progression, 6.3% died without evidence of stage progression) during follow-up (median=842 days). Among subgroups, 12.3% of those without diabetes mellitus progressed vs 24.7% of those with T2DM. One-year mortality increased from 0.5% in uncomplicated NAFLD to 22.7% in HCC. After liver transplant, mortality decreased to 5.6% per year.ConclusionsIn 2.3 years of follow-up, approximately 17% of patients progressed or died without evidence of stage progression. T2DM was associated with approximately twice the risk of disease progression, and mortality risk increased with disease stage. Early diagnosis and monitoring of disease progression, especially in patients with T2DM, is warranted.

Metabolic risk factors and incident advanced liver disease in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of population-based observational studies

“…Studies were included from Europe (Sweden [21,22,[26][27][28]33,37,38], UK [20,32], Italy [20], Netherlands [20], and Spain [20]), North America (US [23,25,[29][30][31]34,[39][40][41] and Canada [36]), and Asia (Singapore [24] and China [35]), with data on over 24 million individuals. All the eligible studies were prospective or retrospective cohorts in design, and were all community-based general population cohorts, some defined by data linkage.…”

“…All of the included studies excluded individuals drinking alcohol at harmful levels and those with alcohol-related liver disease at cohort entry, or adjusted for alcohol consumption during analysis. In 6 of the studies, representing 4 of the cohorts, part of the population under study had a predefined diagnosis of NAFLD, defined using ultrasound, abnormal liver blood tests, or International Classification of Diseases (ICD) coding at the time of cohort entry [20,25,31,[38][39][40]. In 8 of the studies, the cohort studied included only men or women, but was otherwise an approximately general population.…”

Association of fatty liver disease with mortality outcomes in an Eastern Finland male cohort

“…Similarly, Lazo et al 8 found no association between ultrasound diagnosed NAFLD and increased risk of all-cause, cardiovascular or cancer mortality outcomes. In addition, reports from studies with ultrasound diagnosed FLD suggest increased scores of algorithm-based assessed markers of fibrosis are associated with different mortality outcomes among NAFLD subjects 9–11. However, reports from studies using algorithm-based surrogate of fatty liver suggest disparate associations 12–15.…”

Value of the Triglyceride Glucose index Combined with Body Mass index in Predicting non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes

“…In a retrospective study assessing the clinical characteristics and initial disease severity of patients with NAFLD and the incidence and risk factors of NAFLD progression [12], 12.3% of NAFLD-free patients showed progression, 24.7% of patients with NAFLD combined with T2DM progressed. The risk of T2DM and disease progression is about twice the risk of T2DM-free disease progression, and the mortality risk increases as the disease progresses.…”