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Tracking outcomes in adults with nonalcoholic fatty liver disease

A study following people with NAFLD has shown a direct link between disease stage and outcomes, with severe, later-stage disease associated not only with a higher risk of liver-related complications and death, but also with complications in other organ systems. NAFLD, in which fatty deposits form in the liver, affects a large and increasing portion of the population in the United States and around the world. It is often found with other chronic metabolic diseases, such as obesity and type 2 diabetes. In its more severe form of nonalcoholic steatohepatitis, inflammation and fibrosis (scarring and tissue damage) can occur. More detailed knowledge of disease outcomes could help inform clinical care and design clinical research on new treatments.

This study by investigators in the Nonalcoholic Steatohepatitis Clinical Research Network followed a cohort of adult women and men with nonalcoholic fatty liver disease who were mostly White and of European ancestry. The researchers analyzed participants’ liver biopsies to assess disease stage based on how much fibrosis was present and tracked major outcomes, including complications in the liver and other organs. They found that risk of death and liver-related complications that compromised organ function, including liver cancer, increased in those individuals with more severe stages of fibrosis, such as cirrhosis. Almost all individuals with later-stage fibrosis showed evidence that they had the more severe form of NAFLD, nonalcoholic steatohepatitis. Late-stage disease was also associated with signs of complications in other organ systems throughout the body, including more type 2 diabetes and hypertension, as well as reduced kidney function.

These findings linking outcomes to disease stage add to the evidence base for determining prognosis and informing clinical care for NAFLD. Identifying these direct relationships between disease stage and clinical outcomes is important for providing more options to test new therapeutic approaches. Applying the results of this study to the general population is limited, however, by the lack of diversity in the study population. Thus, more research is needed to collect data in additional populations and determine whether these results are broadly generalizable.

Sanyal AJ, Van Natta ML, Clark J, …Tonascia J for the NASH Clinical Research Network. Prospective study of outcomes in adults with nonalcoholic fatty liver disease. N Engl J Med 385:1559-1569, 2021.

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