NASH and NAFLD

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http://medicalnewstoday.com/medicalnews.php?newsid=53553

A new study found that patients with non-alcoholic fatty liver disease (NAFLD)

had a significant risk of developing end-stage liver disease and a lower chance

of survival if they had non-alcoholic steatohepatitis (NASH), a form of NAFLD

that can lead to cirrhosis. The study also found that most NAFLD patients will

eventually develop diabetes or impaired glucose tolerance, which can lead to

cardiovascular complications.

The results of this study appear in the October 2006 issue of Hepatology, the

official journal of the American Association for the Study of Liver Diseases

(AASLD). Published by Wiley & Sons, Inc., Hepatology is available online

via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

Patients with NAFLD, one of the most common causes of liver disease worldwide,

often have elevated liver enzymes but no symptoms of the disease. Obesity has

been established as a major risk factor for NAFLD and since it is reaching

epidemic proportions worldwide, the number of people at risk for developing

chronic liver disease is likely to increase in the future. Studies conducted on

NAFLD to date have either had small numbers of patients or relatively short

follow-up periods. The current study involved the largest reported number of

NAFLD patients originally referred because of elevated liver enzymes and

followed the patients for more than ten years.

Led by Stergios Kechagias, M.D. of the Division of Internal Medicine at

University Hospital in Linkping, Sweden, the study involved 212 patients between

1988 and 1993 who had chronically elevated liver enzymes. All of the patients

underwent liver biopsy, and only the 129 patients who had confirmed fatty liver

without excessive alcohol consumption or other liver disease participated in the

study. A total of 88 patients accepted follow-up at an average of almost 14

years from when they were diagnosed with NAFLD. Of these, 68 patients underwent

repeat liver biopsy.

The results showed that NAFLD was found to be associated with a significant risk

of developing end-stage liver disease and that death from liver-related causes

and cardiovascular diseases was significantly more common in the 71 patients

with NASH than in the general population. In addition, 78 percent of NAFLD

patients were diagnosed with diabetes or impaired glucose tolerance at

follow-up. " Given the strong association between insulin resistance and NAFLD it

is reasonable to recommend lifestyle modifications in all patients with NAFLD, "

the authors state. " Not only do lifestyle modifications reduce the risk of

developing type 2 diabetes, intense dietary intervention may also improve liver

histology in NAFLD. "

In an accompanying editorial in the same issue, Vlad Ratziu and Thierry Poynard

of the Universite Pierre et Marie Curie and Assistance Publique-Hopitaux de

Paris in Paris, highlight the widespread misconception that NAFLD in its various

forms is largely considered to be a mild disease with a good prognosis. They

note that NAFLD patients are usually not referred to hepatologists and the only

way to accurately diagnose the disease (liver biopsy) is not practical as a

screening tool for large populations. Nonetheless, NASH is an important cause of

advanced liver disease and it is important to prevent its progression to

cirrhosis because once liver failure occurs in these cases the outcome is often

fatal. They note that the current study is important not only because of its

long follow-up period, but because the authors were able to identify the outcome

of different forms of NAFLD. " Remarkably, and possibly because of the longer

follow-up, the authors were able to show that even patients without cirrhosis

developed ESLD [end-stage liver disease], thus refuting the claim that

non-cirrhotic NASH is 'benign.' " They add that the study, along with previously

published data, points to the necessity of studying the risk of increased

cardiovascular deaths in NASH patients. They conclude that treating NASH is a

" major unmet medical need, " and that strategies for screening patients with risk

factors for liver disease, including obesity, diabetes and heart disease, should

be developed.

###

Article: " Long-Term Follow-up of Patients With NAFLD and Elevated Liver

Enzymes, " Mattias Ekstedt, Lennart E. Franzn, Ulrik L. Mathiesen, Lars

Thorelius, Marika Holmqvist, Gran Bodemar, Stergios Kechagias, Hepatology;

October 2006 (DOI: 10.1002/hep.21327).

Editorial: " Assessing the Outcome of Nonalcoholic Steatohepatitis? It's Time to

Get Serious, " Vlad Ratziu and Thierry Poynard, Hepatology; October 2006 (DOI:

10.1002/hep.21391).

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