Elsevier

Journal of Hepatology

Volume 62, Issue 5, May 2015, Pages 1148-1155
Journal of Hepatology

Research Article
Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: Implications for prognosis and clinical management

https://doi.org/10.1016/j.jhep.2014.11.034Get rights and content
Under a Creative Commons license
open access

Background and Aims

There remains uncertainty about the natural history of non-alcoholic fatty liver disease (NAFLD). The spectrum of NAFLD includes non-alcoholic fatty liver (NAFL; steatosis without hepatocellular injury) and steatohepatitis (NASH; steatosis with hepatocyte ballooning degeneration ± fibrosis). Our aim was to assess the histological severity of NAFLD in a cohort with serial biopsy data, and determine factors predicting progression.

Methods

Patients with two liver biopsies more than a year apart were identified. Clinical and laboratory data were collected from the time of liver biopsy.

Results

108 patients had serial biopsies (median interval 6.6 years, range 1.3–22.6). 81 (75%) patients had NASH and 27 had NAFL. Overall, 45 (42%) patients had fibrosis progression, 43 (40%) had no change in fibrosis, while 20 (18%) had fibrosis regression. Importantly, no significant difference in the proportion exhibiting fibrosis progression was found between those with NAFL or NASH at index biopsy (37% vs. 43%, p = 0.65). Progression to NASH was seen in 44% of patients with baseline NAFL. Of 10 patients with NAFL who had fibrosis progression, 3 progressed by 1 stage, 5 by 2 stages and 2 by 3 stages; all had NASH on follow-up biopsy. Of concern, 6 of 27 (22%) patients with baseline NAFL, reached stage 3 fibrosis at follow-up biopsy. Among the patients with NAFL, 80% of those having fibrosis progression were diabetic at the follow-up liver biopsy compared with 25% of non-progressors (p = 0.005).

Conclusions

Contrary to current dogma, this study suggests that steatosis can progress to NASH and clinically significant fibrosis.

Keywords

NAFLD
NASH
Steatohepatitis
Fibrosis
Cirrhosis

Cited by (0)

These authors share senior authorship.

Current address: School of Medicine, Eleanor Harrald Building, Frome Road, University of Adelaide, Australia.