While NAFLD is mostly benign, left unaddressed it can develop into a much more harmful disease-state called non-alcoholic steatohepatitis NASH , which involves inflammation of the liver.
Fibrosis can develop into advanced scarring cirrhosis or liver cancer. NAFLD is so common in individuals with this illness that some researchers believe it is the hepatic manifestation of metabolic syndrome and should become part of the diagnostic criteria. They even suggest the usefulness of ultrasonically-detected NAFLD as a diagnostic tool for metabolic syndrome.
One study found that individuals who had NAFLD along with type 2 diabetes were more likely to die from liver disease than those without diabetes. Most new mothers are aware that specific habits during pregnancy, such as tobacco and alcohol consumption, can have a powerful effect on the health of the child. However, the type of food mothers eat can also cause issues. Accessed July 20, Sheth SG, et al.
Epidemiology, clinical features, and diagnosis of nonalcoholic fatty liver disease in adults. Kellerman RD, et al. Nonalcoholic fatty liver disease. In: Conn's Current Therapy Elsevier; Accessed July 26, Wijarnpreecha K, et al. Coffee consumption and risk of nonalcoholic fatty liver disease: A systematic review and meta-analysis. European Journal of Gastroenterology and Hepatology. Ludwig J, et al. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.
Mayo Clinic Proceedings. Merck Manual Professional Version. Malhi H, et al. Nonalcoholic fatty liver: Optimizing pretransplant selection and posttransplant care to maximize survival.
Current Opinion in Organ Transplantation. Heimbach JK, et al. Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. American Journal of Transplantation. Bazerbachi F, et al. Population based studies have shown increased risk of women developing alcohol-induced cirrhosis [ 23 — 26 ].
Progression of NAFLD has been found to be slow and seems to depend a great deal on the initial fibrosis stage [ 8 , 14 ]. Patients with simple fatty liver at baseline seem to have a good prognosis in terms of liver disease.
In a Danish study of patients diagnosed with pure non-alcoholic simple steatosis without inflammation or significant fibrosis only one of the patients developed cirrhosis [ 8 ]. In the total study cohort patients with more severe fibrosis at baseline showed a worse overall survival than patients with none or mild fibrosis at baseline. Based on this we were able to show an association in the total study cohort between the stage of fibrosis and the prognosis. This is in agreement with results from a recent study showing that advanced fibrosis in the index liver biopsy was the most important predictor of the prognosis in these patients [ 27 ].
A recent Danish study showed that the cirrhosis risk was more than twice as high for the patients with steatohepatitis than for those with pure steatosis [ 26 ].
A Swedish cohort study of patients with biopsy-proven NAFLD and elevated liver tests showed that they had a similar survival compared to the Swedish population [ 7 ]. Interestingly the risk of death was increased in patients with non-alcoholic steatohepatitis [ 7 ]. This is similar to our results showing liver-related to be the third most common cause of death amongst the NAFLD group.
However in the AFLD group liver-related death was the leading cause of death, followed by cardiovascular diseases and malignancy which is in accordance to a previous study where hepatobiliary disease was the leading cause of death in the AFLD [ 9 ]. A reasonable explanation for this difference in our study could be that our patients had in general mild changes in the liver biopsy at baseline.
It is also conceivable that a longer follow-up time would probably lead to patients with HCC. In agreement with many previous studies a markedly higher proportion of our women in the NAFLD group died of cardiovascular disease compared to women in the AFLD group, 17 patients vs.
A previous study [ 10 ] showed that cardiovascular disease was the leading cause of death in the AFLD group men and women toghether , which is at odd with our results. In the current study the leading cause of death in the AFLD group was liver related. We can not find a plausible explanation for this difference, although it has been shown that diagnoses on death certificates can underestimate liver-related mortality [ 28 ] which might have been the case in the Danish study [ 10 ].
The most common cause of death in the NAFLD group was from cardiovascular disease, followed by malignancy which is in agreement with findings of other cohort studies 6, 7, 14, 16,.
In conclusion a higher proportion of patients with AFLD developed liver cirrhosis and had liver-related death compared to patients with NAFLD in this population based setting and had also more severe histological changes in the liver biopsy at baseline. Dig Dis. Article Google Scholar. Semin Liver Dis. Article PubMed Google Scholar. Angulo P: Nonalcoholic fatty liver disease. N Engl J Med. Scand J Gastroenterol. PubMed Google Scholar. Am J Gastroenterol. A spectrum of clinical and pathological severity.
J Hepatol. Lee GR: Nonalcoholic steatohepatitis: a study of 49 patients. Hum Pathol. Dig Dis Sci. Ann Intern Med. J Hepatology. Aliment Pharmacol Ther. Scan J Gastroent. Download references. You can also search for this author in PubMed Google Scholar. SH conceived and designed the study, acquired data, critically analyzed the results and drafted the article, JGJ analyzed and scored the liver biopsies and contributed to the data discussion, HN acquired data and contributed to the data discussion, SOE analyzed and scored the liver biopsies, DEK analyzed and scored the liver biopsies and contributed to the data discussion, SHL performed the statistical analysis, ESB conceived and designed the study, contributed to the data discussion and participated in its coordination.
All authors read and approved the final manuscript. Reprints and Permissions. Haflidadottir, S. Long term follow-up and liver-related death rate in patients with non-alcoholic and alcoholic related fatty liver disease. BMC Gastroenterol 14, Kamel, M. Brancati, M. Clark, M. Media Contact: Stephanie Desmon ; sdesmon1 jhmi. Contact us or find a patient care location. Privacy Statement. Non-Discrimination Notice.
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