The characteristics and natural history of Japanese patients with nonalcoholic fatty liver disease
ABSTRACT The aim of our study was to elucidate the characteristics and natural history of Japanese nonalcoholic fatty liver disease (NAFLD).
Two hundred and forty-seven patients were diagnosed as having biopsy-proven NAFLD at Tokyo Women's Medical University or an affiliated hospital from 1990 to June 2004. Biopsies were scored for the severity of steatosis, necro-inflammation, and fibrosis according to modified Brunt criteria. We assessed the clinicopathological features and natural history of NAFLD in patients stratified by the stage of their fibrosis. Univariate and multivariate logistic analyses were performed, and the diagnostic ability was assessed by the area under the receiver operating characteristic curve.
Clinicopathological features: The median age of the patients was 53 years, with a range from 10 to 89 years. There were 130 males and 117 females. Histologically, 46 patients were classified as F3 (bridging fibrosis), and 43 patients had F4 (cirrhosis). Females and older patients were more common in the F3-4 patients. Most of the F3-4 patients showed mild elevation of transaminases with significant deterioration of liver function tests compared with F0-2 patients. Ten patients were simultaneously diagnosed as having cirrhotic NASH and hepatocellular carcinoma (HCC). Natural history: During follow-up (median 44 months) of the F3-4 patients, 10 patients developed liver-related morbidity and five patients developed HCC. In the F3-4 patients, the 5-year cumulative incidence of HCC was 20%. Eight patients died (two of liver failure, four of HCC and two of other carcinomas). Serum markers for detecting F3-4: Serum hyaluronic acid levels can accurately evaluate NAFLD patients with F3-4.
The most important consequence of NAFLD patients with advanced fibrosis was HCC. Regular screening for this complication is extremely important.
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- "Although relatively few long-term follow-up studies of patients who have NAFLD have been reported, the accumulating data about liver-specific outcomes are very consistent      . First, it is apparent that in NAFLD, as in other liver diseases, liver-specific morbidity and mortality are largely restricted to individuals who develop cirrhosis. "
ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) refers to a spectrum of liver damage ranging from simple steatosis to nonalcoholic steatohepatitis, advanced fibrosis, and rarely, progression to cirrhosis. The pathogenesis of NAFLD is thought to be related to insulin resistance and oxidant stress. Truncal obesity, dyslipidema, hypertension, and hyperglycemia are strongly associated with NAFLD; therefore, management of NAFLD entails identification and treatment of metabolic risk factors, improving insulin sensitivity, and increasing antioxidant defenses in the liver. This article briefly summarizes advances in our understanding of the relationship between NAFLD and the insulin resistance (metabolic) syndrome, its prevalence, natural history, and treatment.Medical Clinics of North America 12/2007; 91(6):1125-49, ix. DOI:10.1016/j.mcna.2007.06.001 · 2.80 Impact Factor
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- "0 5 10 15 20 25 Angulo (1999) 11 Albano (2005) 14 Mofrad (2003) 15 Beymer (2003) 18 Angulo (2004) 24 Shimada (2004) 16 Dixon (2001) 17 Buigianesi (2004) 19 Suzuki (2005) 23 Hashimoto (2005) 26 Angulo (2004) 24 Sakugawa (2005) 13 Rosenberg (2004) 12 Dixon (2003) 20 Guidorizzi (2005) 22 Marchesini (2003) 25 Hui (2004) 21 Not tested No association UVA MVA Analysis Odds ratio (OR 75, UL 1247) n = 144 n = 226 n = 51 n = 48 n = 88 n = 81 n = 105 n = 167 n = 79 n = 247 n = 88 n = 112 n=55 n = 105 n = 64 n = 163 n = 191 "
ABSTRACT: The diagnosis of fibrosis within liver disease is important for prognosis, stratification for treatment, and monitoring of treatment efficacy. The rising incidence and prevalence of non-alcoholic fatty liver disease (NAFLD) has driven the search for accurate non-invasive tools of liver fibrosis within this condition. With the aid of a systematic review, we explore how the field has evolved from the discovery of simple blood parameters to panel markers of liver fibrosis. We will discuss the biological plausibility, limitations, potential uses, and emerging diagnostic techniques of non-invasive markers in this rapidly expanding field.Gut 12/2006; 55(11):1650-60. DOI:10.1136/gut.2006.091454 · 13.32 Impact Factor
- Gut 02/2006; 55(1):135-6. · 13.32 Impact Factor