COMMENTARY

Fatty Liver Takes Center Stage

Digestive Disease Week (DDW) 2013

William F. Balistreri, MD

Disclosures

June 04, 2013

In This Article

The Long-term Consequences of Liver Disease

An aggressive evaluation approach is clearly warranted because of the high potential impact of NAFLD. NAFLD is known to be associated with increased morbidity and overall mortality. This was also emphasized in studies presented here.

The impact of NAFLD was quantified in an analysis of data from the National Health and Nutrition Examination Survey (NHANES) III.[4] Investigators determined the overall and cause-specific mortalities in patients with NAFLD, finding that 22% of the more than 10,000 patients had NAFLD. Those with NAFLD had higher overall mortality compared with control patients, and most deaths were due to cardiovascular events. The independent predictors of mortality in these patients were male sex, older age, increased waist circumference, and low high-density lipoprotein levels. Serum alanine aminotransferase (ALT) levels and the presence of metabolic syndrome were not predictive of mortality.

Speakers also reported an association between NAFLD-associated fibrosis and mortality.[5] Compared with patients without fibrosis, those with advanced fibrosis had a 69% increase in mortality. The increased deaths were almost always the result of cardiovascular causes.

Another long-term impact of NAFLD was highlighted. Fatty liver disease is an increasingly common indication for liver transplant. However, metabolic syndrome is a common complication after transplantation for this disorder. Investigators here[6] reported the effects of metabolic syndrome on outcomes. The occurrence of metabolic syndrome at 6 months post-transplant was associated with excess hospitalizations for infections within the first year, and for cardiovascular disease after the first transplant year. The data strongly support the concept that aggressive management of metabolic syndrome and associated conditions will lead to improved outcomes. Several investigators discussed potential mechanisms of steatohepatitis. It is clear that the pathogenesis is multifactorial, with contributions from genetic and environmental factors.

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