The Natural History of Non-Alcoholic Fatty Liver Disease

Abstract

Non-alcoholic fatty liver disease has a variable prognosis which is predictable to an extent based on the presence or absence of histological liver injury. Past studies have determined a number of clinical and laboratory parameters which predict greater severity on the initial biopsy, although all of these measures have limitations and biopsy remains the gold standard at this time. For patients with early stage non-alcoholic steatohepatitis (NASH), about one third will progress to stage 3 or 4 (cirrhosis) over 5–10 years. Thus, early-stage NASH constitutes one of the groups most likely to benefit from treatments now undergoing investigation. Among those who progress to NASH cirrhosis, about 25% will develop major complications of portal hypertension within 3 years. In contrast, non-NASH fatty liver tends to be stable over time, although there appears to be an increased cancer risk in all forms of fatty liver, albeit greater in NASH compared to non-NASH fatty liver. Interestingly, the cause of death among patients with NASH is more often due to cardiovascular disease or non-liver malignancy than cirrhosis. However, the accelerated risk of cirrhosis in this group compared to cardiovascular disease suggests that this picture is likely to change in the foreseeable future. Meanwhile, the relationship between these comorbidities will increasingly lead to patients with both coronary disease or malignancy and NASH-related cirrhosis presenting clinicians with a very challenging set of problems in coming years.

Noninvasive predictors for liver fibrosis in patients with nonalcoholic steatohepatitis

“…The natural progression of fatty liver is not definitely estimated previously. While approximately 7%-37.6% of patients with non-alcoholic steatohepatitis (NASH) may have advanced fibrosis and 20% of patients with NASH may silently progress to cirrhosis, fatty liver should not always be considered as an innocent condition [4][5][6][7] . Due to the difficulties in extensive application of liver biopsy, many anthropometric, clinical and laboratory features in NASH patients were investigated for their currency and worthiness in the prediction of liver fibrosis.…”

Current role of fenofibrate in the prevention and management of non-alcoholic fatty liver disease

“…In NASH, beyond lipid accumulation, necroinflammation and fibrosis exist [2,3] . Approximately 29% of NASH patients will develop cirrhosis within 10 years [4] . End-stage liver disease and hepatocellular carcinoma are liver-specific endpoints of NAFLD [3][4][5] .…”

“…Approximately 29% of NASH patients will develop cirrhosis within 10 years [4] . End-stage liver disease and hepatocellular carcinoma are liver-specific endpoints of NAFLD [3][4][5] . NAFLD is a common health problem affecting up to 35% of the population in several countries [5] .…”

NAFLD therapy and monitoring disease progression

“…The spectrum of NAFLD ranges from simple steatosis or non alcoholic steatosis (NAFL) to non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma (HCC). 1 Hepatic steatosis is considered pathological when it affects > 5% of the hepatocytes. 2 Patients with NAFL have the presence of fat in the liver, with or without the presence of mild lobular inflammation.…”