Decreased survival of subjects with elevated liver function tests during a 28-year follow-up

Abstract

The long-term survival of subjects with nonalcoholic fatty liver disease (NAFLD) in comparison with both individuals with elevated transaminases attributable to other causes and the general poulation is poorly characterized. This study was undertaken to determine the frequency of NAFLD in a cohort of subjects who underwent liver biopsy from 1980 to 1984 because of elevated liver enzymes, and to assess mortality among subjects with NAFLD in comparison with the general Swedish population. The 256 subjects (61% men) had a mean age of 45 ؎ 12 years at the inclusion. Liver biopsies were blindly scored for NAFLD and nonalcoholic steatohepatitis (NASH). Causes of death were ascertained from the national Swedish Cause of Death Registry.

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…4,7 The long term outcomes of patients with NAFLD and NASH have been reported in several studies. 31,[38][39][40][41][42][43][44][45] Their detailed discussion is beyond the scope of this guideline, but their findings can be summarized as follows; (a) patients with NAFLD have increased overall mortality compared to matched control populations, (b) the most common cause of death in patients with NAFLD, NAFL and NASH is cardiovascular disease, and (c) patients with NASH (but not NAFL) have an increased liver-related mortality rate.…”

“…The effect of metformin administered at a higher dose is not known. (Strength -1, Quality -B) 45. Vitamin E 800 IU/day (RRR a-tocopherol) offers histological benefits to children with biopsyproven NASH or borderline NASH but confirmatory studies are needed before its use can be recommended in clinical practice (Strength -1,Quality -B)…”

Natural history of nonalcoholic fatty liver disease: A prospective follow‐up study with serial biopsies

“…Some patients with NAFLD develop progressive fibrosis and subsequent cirrhosis with an increased risk of hepatocellular carcinoma 6. The prevalence of cirrhosis among patients with NAFLD is approximately 5%, and patients with NAFLD have an increased mortality compared to control populations 7, 8, 9. Today, NAFLD is the second leading etiology among adult patients awaiting liver transplant in the United States 10…”

Hepatic fibrosis developing in morbid obesity independent of steatohepatitis: new mechanism or the Rube Goldberg machine?

“…Steatohepatitis was also shown to be associated with increased mortality. When 118 persons with NAFLD were followed up for a mean period of over 20 years, persons with NASH had a significant increase in mortality, whereas those with steatosis alone did not [4].…”