We cannot ICG-001 rule out NASH cases being excluded (e.g., those with NASH and steatosis <5%), but, as a result of the workup to exclude other etiologies, all included cases were managed clinically as NAFLD. Logistically, it was not possible to match every patient with NAFLD by age and gender with patients with HCV infection; however, only age was shown
to have an independent effect on outcomes. We also adjusted the comparisons by age, sex, BMI, and the presence of diabetes and dyslipidaemia without discernible differences. There may be residual confounding by some parameters: For example, diabetes status differed significantly between NALFD and HCV, and even though this was adjusted for, this cannot account for severity of disglycemia. Moreover, follow-up for medical problems that
may have an effect, such as de novo diabetes see more mellitus, were not assessed systematically (although insulin resistance may play a role in HCV as well as in NAFLD).17 Nor can we rule out effects of later medications for the treatment of comorbidities, although no pharmacological treatments have been shown reliably to have a substantive effect on liver fibrosis in NAFLD.18 This also applies to any effects of nonpharmacological treatments, such as exercise or diet.19 Practice and follow-up obviously varied between the centers, although this does not affect the systematic prospective methodology used, nor should it significantly affect the event predictors. Compared to the general population, NAFLD has been associated with an increased risk of overall death (standardized mortality ratio: 1.34; 95% CIs: 1.003-1.76) in a community-based study of 420 patients selleck chemicals from the United States.20 In a similar Swedish study, just over 5% of
the 129 NAFLD patients enrolled went on to develop end-stage liver disease.21 In both studies, there was a higher vascular- and liver-related mortality in patients with NAFLD (as compared to the general population of the same age and sex). In contrast to patients with other liver diseases, the short-term prognosis of NAFLD is largely excellent, but longer term prognosis depends crucially on histological stage at presentation.6, 22 In patients with bland steatosis, two studies have reported either nil23 or minimal progression24 to advanced disease over a median of 11.5 and 16.7 years, respectively. For those with NASH on baseline liver biopsy, 11% went on to develop cirrhosis and ∼40% of patients die from any cause within 15 years (of which 7.3% are from liver-related complications, especially in those with advanced fibrosis or cirrhosis).6 Studies with subsequent liver biopsy have also prospectively evaluated the risk of fibrosis progression over time. One hundred three patients underwent two liver biopsies 1-21 years apart: Baseline low fibrosis stage, diabetes, and greater BMI were independently associated with fibrosis progression.