‘Non-alcoholic fatty liver disease patients have higher mortality rates’

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Washington, January 28 : Patients with nonalcoholic fatty liver disease (NAFLD) are at greater risk of death than the general population, say researchers.

Experts at the Karolinska Institute sought to determine the association of NAFLD, the most common cause of elevated liver enzyme levels, with mortality rate as part of their study.

Principal investigator Dr. Cecilia Svderberg said: “We wanted to determine the frequency of NAFLD and NASH in a population of subjects with elevated serum levels of aminotransaminases and compare the survival and causes of death in NAFLD subjects with those of subjects from other liver diseases, and the general population.”

Dr. Svderberg explained: “This study has four major strengths. Firstly, all the subjects were enrolled consecutively during a defined period of time (1980-1984). Secondly, all underwent liver biopsy at the time of referral so that the diagnoses of NAFLD are based on histological criteria. Thirdly, re-evaluation of the initial biopsy findings was performed in all cases. And finally, even deceased subjects could be followed up through the Cause of Death Registry, so that there were no losses during follow-up.”

Boffins found that patients with NAFLD and NASH had a much higher risk of death than the general population but not as high a risk as for patients with chronic viral hepatitis or alcoholic liver disease. Cardiovascular disease and extra-hepatic malignancies were the primary and secondary causes of death among patients with NAFLD whereas liver-related causes were the third.

Dr. Paul Angulo from the University of Kentucky, however, cast a shadow of doubt over the research, saying: “The study by Svderberg et al. suggests that in using the NASH-CRN scoring system the long-term mortality of those with definitive NASH is not significantly different from those with non NASH. Unfortunately, the study by Svderberg et al. along with the two other past studies that included liver biopsy, did not analyze the prognostic relevance of inflammation and hepatocyte ballooning adjusted by presence and severity of fibrosis.”

He pointed out that “only a large appropriately powered study of several hundreds of patients who underwent liver biopsy and have follow-up data for several years or decades will answer those questions.”

The study was published in Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases. (ANI)