Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity

CA Matteoni, ZM Younossi, T Gramlich, N Boparai… - Gastroenterology, 1999 - Elsevier
CA Matteoni, ZM Younossi, T Gramlich, N Boparai, YC Liu, AJ McCullough
Gastroenterology, 1999Elsevier
Background & Aims: The spectrum of nonalcoholic fatty liver disease ranges from fatty liver
alone to nonalcoholic steatohepatitis. Most previous studies have short follow-up and have
not carefully delineated different histological types when determining clinical outcomes. The
aim of this study was to compare clinical characteristics and outcomes of patients with
different types of nonalcoholic fatty liver. Methods: All liver biopsy specimens from 1979 to
1987 with fat accumulation were assessed for inflammation, ballooning degeneration …
Background & Aims
The spectrum of nonalcoholic fatty liver disease ranges from fatty liver alone to nonalcoholic steatohepatitis. Most previous studies have short follow-up and have not carefully delineated different histological types when determining clinical outcomes. The aim of this study was to compare clinical characteristics and outcomes of patients with different types of nonalcoholic fatty liver.
Methods
All liver biopsy specimens from 1979 to 1987 with fat accumulation were assessed for inflammation, ballooning degeneration, Mallory hyaline, and fibrosis. Biopsy specimens were also assessed for histological iron and hepatitis C RNA. Outcomes were cirrhosis, mortality, and liver-related mortality.
Results
Of 772 liver biopsy specimens, complete data were available in 132 patients. Fatty liver (type 1) did not differ from the other three types combined with respect to gender, race, age, or obesity. Cirrhosis was more common in the other types combined (22%) than fatty liver alone (4%; P ≤ 0.001). Overall mortality, histological iron, and hepatitis C did not differ between groups. Most of the liver-related deaths were in type 4.
Conclusions
The outcome of cirrhosis and liver-related death is not uniform across the spectrum of nonalcoholic fatty liver. These poor outcomes are more frequent in patients in whom biopsies show ballooning degeneration and Mallory hyaline or fibrosis. GASTROENTEROLOGY 1999;116:1413-1419
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