Prognosis and staging of non-alcoholic fatty liver disease

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7302 (Published 18 November 2011) Cite this as: BMJ 2011;343:d7302
  1. Peter Jepsen, MD,
  2. Henning Grønbæk, associate professor
  1. 1Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, DK-8000 Aarhus, Denmark
  1. pj{at}dce.au.dk

Impact of staging on mortality is unclear, and liver biopsy remains the definitive method

Non-alcoholic fatty liver disease includes several stages—from simple steatosis to non-alcoholic steatohepatitis with inflammation, progressive fibrosis, and ultimately cirrhosis. In clinical practice the diagnosis of non-alcoholic fatty liver disease is based on increased echogenicity on ultrasound and raised liver enzymes (alanine aminotransferase or aspartate aminotransferase); staging requires a liver biopsy. The risk of complications after liver biopsy is justified by the prognostic information gained: simple steatosis has a small, if any, effect on mortality, whereas non-alcoholic steatohepatitis has repeatedly been associated with increased mortality, primarily from cardiovascular disease, but also from liver disease.1 2

It is unclear whether non-alcoholic steatohepatitis is an independent risk factor for cardiovascular mortality or whether the association can be explained by the higher prevalence of the metabolic syndrome. The linked cohort study by Lazo and colleagues (doi:10.1136/bmj.d6891) uses data from the NHANES III (Third National Health and Nutrition Examination Survey) 1988-94 cohort, which is ideally placed to answer this question.3 The …

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