Fibrosis progression in NAFLD vs NASH

Fibrosis progression in NAFLD vs NASH 

34% had fibrosis progression at follow-up evaluation
Clinical Gastroenterology & Hepatology

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A study in April's Clinical Gastroenterology & Hepatology estimates the rates of fibrosis progression in patients with nonalcoholic fatty liver disease and NASH.

Little is known about differences in rates of fibrosis progression between patients with nonalcoholic fatty liver (NAFL) vs nonalcoholic steatohepatitis (NASH).

Professor Rohit Loomba and colleagues from California, USA conducted a systematic review and meta-analysis of all studies that assessed paired liver biopsy specimens to estimate the rates of fibrosis progression in patients with nonalcoholic fatty liver disease (NAFLD) including NAFL and NASH.

Through a systematic search of multiple databases and author contact, up to 2013, the researchers identified studies of adults with NAFLD that collected paired liver biopsy specimens at least 1 year apart.

From these, the team calculated a pooled-weighted annual fibrosis progression rate with 95% confidence intervals, and identified clinical risk factors associated with progression.


The researchers identified 11 cohort studies including 411 patients with biopsy-proven NAFLD.

At baseline, the distribution of fibrosis for stages 0, 1, 2, 3, and 4 was 33%, 33%, 17%, 9%, and 6%, respectively.

The team observed that over 2146 person-years of follow-up evaluation, 34% had fibrosis progression, 43% had stable fibrosis, and 22% had an improvement in fibrosis stage.

The annual fibrosis progression rate in patients with NAFL who had stage 0 fibrosis at baseline was 0.07 stages, compared with 0.14 stages in patients with NASH.

The team found that these findings correspond to 1 stage of progression over 14 years for patients with NAFL, and 7 years for patients with NASH.

Professor Loomba's team commented, "Based on a meta-analysis of studies of paired liver biopsy studies, liver fibrosis progresses in patients with NAFL and NASH."

Clin Gastroenterol Hepatol 2015: 13(4): 643–654.e9
23 March 2015