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Alloveda Liver Update: Natural History of NAFLD: A Study with Paired Liver Biopsies

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A study looked into the rate of progression to NASH and advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and also determined the factors associated with progression.

Thirty six patients with NAFLD were subjected to histological assessment with paired liver biopsies (≥1 year apart; median, 3.8 years). NASH Clinical Research Network (NASH CRN) criteria helped evaluate the NAFLD Activity Score (NAS).

At baseline, 72% of the patients had NAFL and 28% had NASH. At follow-up, 27% NAFL was found to progress to NASH (NAS score ≥5), while 50% of patients with NASH no longer fulfilled the criteria of NASH.

Fibrosis progressed in 42%, regressed in 25%, and remained stable in 33% patients. Nearly 35% of the patients with NAFL had fibrosis progression. It was noted that the incidence of type 2 diabetes mellitus (T2DM) was higher in patients with NASH compared to NAFL (40% vs. 27%). At baseline as well as at the time of follow-up, liver biopsies, composite models of noninvasive scores [Fibrosis-4 (FIB-4) score and NAFLD fibrosis score, and ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT)] were found to be significantly higher in progressors compared to nonprogressors.

NAFLD presents with varying degrees of progression and regression. T2DM has a robust link with fibrosis progression. Noninvasive fibrosis scores, including AST/ALT ratio, FIB-4 score, and NAFLD fibrosis score, have the potential to identify those at risk of fibrosis progression.

Source: Reddy YK, Marella HK, Jiang Y, et al. Natural History of Non-Alcoholic Fatty Liver Disease: A Study With Paired Liver Biopsies. J Clin Exp Hepatol. 2020 May-Jun;10(3):245-254.

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