Non-alcoholic fatty liver disease natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

NASH may progress to fibrosis and, later, cirrhosis. Studies of serial liver biopsies estimate a 26-37% rate of hepatic fibrosis and 2-15% rate of cirrhosis in less than 6 years.The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies.The natural history of nonalcoholic fatty liver disease:a clinical histopathological study.Long-term follow-up of patients with NAFLD and elevated liver enzymes. In 2001, NASH represented 2.9% of the indications of liver transplantation.The frequency of Nonalcoholic Steatohepatitis as a Cause of Advanced Liver Disease. The impact of NAFLD is manifest at each step along the spectrum of the disease. Studies in the United States and Sweden have revealed that both simple steatosis as well as steatohepatitis significantly reduce life expectancy, even when the diagnosis is made in children.The natural history of the non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years.

Natural History, Complications and Prognosis

Natural History

• The symptoms of NAFLD usually develop in the 40th decade of life, And usually asymptomatic at first.
• After following NAFLD patients for long-term the outcome of the disease is as follows
  • 1) Patients with NAFLD has overall high morbidity and mortality rate and the common cause of death in NAFLD patients is cardiovascular disease.
  • 2) Patients with NASH has more liver-related mortality rate
• If left untreated, Patients with NAFLD may progress to develop hepato cellular carcinoma (HCC). But it is directly propotional to the degree of fibrosis and advanced cirrhosis
• Children who are positive with NAFLD are also prone to short lifespan when compared to general population.

Complications

• Common complications of NAFLD include:
  • Fibrosis
  • Cirrhosis
  • Internal bleeding
  • Encepholopathy

NAFLD Activity Score (NAS)

STEATOSIS	S SCORE	COMMENT
<5%	0	Refers to the quantity of surface area involved by means of steatosis as evaluated on low to medium power examination; minimum steatosis (<5%) gets a rating of 0 to keep away from giving excess weight to biopsies with little or no fatty change.
5–33%	1
34–66%	2
>66%	3
Lobular Inflammation	L SCORE
None	0	Acidophil bodies are not protected by this evaluation, neither is the portal irritation.
<2 foci	1
2–4 foci	2
>4 foci	3
Hepatocyte Balloning	B score
None	0
Few ballooned cells	1	The term "few" means rare however specific ballooned hepatocytes as well as cases which are diagnostically borderline.
Many ballooned cells	2	Maximum cases with distinguished ballooning additionally had Mallory's hyaline, howeverMallory's hyaline isn't scored one after the other for the NAS .

Prognosis

• Histology is the most reliable means to grade the severity of the disease and thus estimate prognosis because the diagnostic criteria for NAFLD as of now is low.
• The initial biopsy at the time of the diagnosis appears to be very valuable to predict the diagnosis.
• Depending on the extent of the fibrosis and cirrhosis at the time of diagnosis, the prognosis may vary.
• The presence of fibrosis and cirrhosis associated with a particularly poor prognosis among patients with NAFLD.