Long term prognosis of fatty liver: risk of chronic liver disease and death

Background and aims: Fatty liver is a common histological finding in human liver biopsy specimens. It affects 10–24% of the general population and is believed to be a marker of risk of later chronic liver disease. The present study examined the risk of development of cirrhotic liver disease and the risk of death in a cohort diagnosed with pure fatty liver without inflammation. Methods: A total of 215 patients who had a liver biopsy performed during the period 1976–1987 were included in the study. The population consisted of 109 non-alcoholic and 106 alcoholic fatty liver patients. Median follow up time was 16.7 (0.2–21.9) years in the non-alcoholic and 9.2 (0.6–23.1) years in the alcoholic group. Systematic data collection was carried out by review of all medical records. All members of the study cohort were linked through their unique personal identification number to the National Registry of Patients and the nationwide Registry of Causes of Death, and all admissions, discharge diagnoses, and causes of death were obtained. Results: In the non-alcoholic fatty liver group, one patient developed cirrhosis during the follow up period compared with 22 patients in the alcoholic group. Survival estimates were significantly (p<0.01) different between the two groups, for men as well as for women, with a higher death rate in the alcoholic fatty liver group. Survival estimates in the non-alcoholic fatty liver group were not different from the Danish population. Conclusions: This study revealed that patients with type 1 non-alcoholic fatty liver disease have a benign clinical course without excess mortality.

[1]  B. Neuschwander‐Tetri Fatty liver and nonalcoholic steatohepatitis. , 2001, Clinical cornerstone.

[2]  P. Christoffersen,et al.  Liver histology in a 'normal' population--examinations of 503 consecutive fatal traffic casualties. , 1977, Scandinavian journal of gastroenterology.

[3]  M. Bennett,et al.  Determinants of progression to cirrhosis or fibrosis in pure alcoholic fatty liver , 1995, The Lancet.

[4]  J. Dixon,et al.  Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. , 2001, Gastroenterology.

[5]  M. Bennett,et al.  The natural history of nonalcoholic fatty liver: A follow‐up study , 1995, Hepatology.

[6]  Randall G. Lee,et al.  Nonalcoholic steatohepatitis: a study of 49 patients. , 1989, Human pathology.

[7]  K. Ishak,et al.  Histopathology of Hepatitis C Virus Infection , 1995, Seminars in liver disease.

[8]  C. Gluud,et al.  Liver morphology in morbid obesity: a literature study. , 1984, International journal of obesity.

[9]  F. Capron,et al.  Excess weight risk factor for alcoholic liver disease , 1997, Hepatology.

[10]  A. Burt,et al.  Diagnosis and interpretation of steatosis and steatohepatitis. , 1998, Seminars in diagnostic pathology.

[11]  R. Prescott,et al.  A prospective study of alcoholic liver disease and mortality. , 1992, Journal of hepatology.

[12]  T. F. Andersen,et al.  The Danish National Hospital Register. A valuable source of data for modern health sciences. , 1999, Danish medical bulletin.

[13]  Mauro Salizzoni,et al.  Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. , 2002, Gastroenterology.

[14]  C. Day Non-alcoholic steatohepatitis (NASH): where are we now and where are we going? , 2002, Gut.

[15]  F. Schaffner,et al.  Nonalcoholic fatty liver disease. , 1986, Progress in liver diseases.

[16]  T. Sørensen,et al.  Prediction of risk of liver disease by alcohol intake, sex, and age: A prospective population study , 1996, Hepatology.

[17]  P. Giral,et al.  Liver fibrosis in overweight patients. , 2000, Gastroenterology.

[18]  K. Weinbren The pathology of hepatitis. , 1952, The Journal of pathology and bacteriology.

[19]  G. Brandi,et al.  Prevalence of and Risk Factors for Hepatic Steatosis in Northern Italy , 2000, Annals of Internal Medicine.

[20]  G. Marchesini,et al.  NASH: From liver diseases to metabolic disorders and back to clinical hepatology , 2002, Hepatology.

[21]  B. Neuschwander‐Tetri,et al.  Nonalcoholic steatohepatitis: an expanded clinical entity. , 1994, Gastroenterology.

[22]  ThorkildI. A. Sørensen,et al.  PROSPECTIVE EVALUATION OF ALCOHOL ABUSE AND ALCOHOLIC LIVER INJURY IN MEN AS PREDICTORS OF DEVELOPMENT OF CIRRHOSIS , 1984, The Lancet.

[23]  F. Jones,et al.  International Classification of Diseases , 1978 .

[24]  A. Lonardo Fatty Liver and Nonalcoholic Steatohepatitis. Where Do We Stand and Where Are We Going? , 1999, Digestive Diseases.

[25]  Z. Younossi,et al.  Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. , 1999, Gastroenterology.

[26]  K. Krogsgaard,et al.  [Screening of Danish blood donors for hepatitis C virus antibodies]. , 1990, Ugeskrift for laeger.

[27]  K. Batts,et al.  Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis , 1999, Hepatology.

[28]  Ch.M. F.R.C.S. R. Michael Baddeley B.Sc. An epilogue to jejunoileal bypass , 2005, World Journal of Surgery.

[29]  M. Bennett,et al.  The natural history of nonalcoholic fatty liver: A follow‐up study , 1995, Hepatology.

[30]  H. Sørensen,et al.  Data Quality of Administratively Collected Hospital Discharge Data for Liver Cirrhosis Epidemiology , 1997, Journal of Medical Systems.

[31]  C. Day,et al.  Hepatic steatosis: Innocent bystander or guilty party? , 1998, Hepatology.

[32]  T. Sørensen,et al.  Mortality of alcohol abusing men prospectively assessed in relation to history of abuse and degree of liver injury. , 2008, Liver.

[33]  K. Batts,et al.  Frequency of nonalcoholic steatohepatitis as a cause of advanced liver disease , 2001, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[34]  K. Juel,et al.  The Danish registers of causes of death. , 1999, Danish medical bulletin.

[35]  R. Hanson,et al.  The natural history of nonalcoholic steatohepatitis: A follow‐up study of forty‐two patients for up to 21 years , 1990, Hepatology.

[36]  T. Nickelsen,et al.  [Data validity and coverage in the Danish National Health Registry. A literature review]. , 2001, Ugeskrift for laeger.