According to the prospective investigation published in the October issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, the prevalence of liver-related complications and hepatocellular carcinoma (HCC) is lower among individuals who suffer with non-alcoholic fatty liver disease (NAFLD) with advanced fibrosis or cirrhosis, compared to those infected with hepatitis C virus (HCV). Individuals with both NAFLD and HCV had parallel mortality rates.
Worldwide, NAFLD has become the most frequent cause of chronic liver disease, and investigations have reported up to 30% of the general population and 75% of obese people have the disease. A minority of individuals with the disease develop fibrosis or cirrhosis of the liver, and non-alcoholic fatty liver disease together with advanced fibrosis or cirrhosis can result in hepatic-related complications, liver cancer, liver failure or death. Even though the number of cases of the disease has increased, investigations have been limited regarding the natural history of the disease together with advanced fibrosis or cirrhosis and later outcomes.
Lead author Dr. Neeraj Bhala from the University of Oxford in the UK, said: “Our study reports on the long-term morbidity and mortality of NAFLD patients with advanced fibrosis or cirrhosis by prospectively following up cases from four international collaborating hepatology centers. Understanding the long term prognosis of NAFLD patients compared with patients affected by other liver diseases such as chronic HCV was an important aspect of our study.” According to medical evidence although HCV is at present the primary indicator for liver transplantation, which affects over 5 million people in the U.S., the frequency of HCV has leveled, while the prevalence for NAFLD is increasing.
Researchers enrolled 247 individuals with NAFLD in the largest prospective investigation up to now of people with advanced fibrosis or cirrhosis. They also enrolled 264 individuals with HCV infection who had not been treated previously or who were unresponsive to treatment from centers in Australia, Italy, the UK and the USA. Verified by liver biopsy at the start of the investigation, participants in both groups were Child-Pugh class A and had advanced fibrosis (stage 3) or cirrhosis (stage 4). Follow-up in the NAFLD ground was on average 86 months and 75 months for the HCV group.
Out of the participants in the NAFLD group, 19% had liver-related complications and 13% died (or received transplants). In the HCV group 17% had liver-related complications and 9% died (or received transplants). However, after the team adjusted for age and gender, they found that the prevalence of liver-related complications, including HCC, was lower in the NAFLD group in comparison to the HCV group. They discovered that between the two groups, cardiovascular complications and overall mortality were comparable, even though moderate differences cannot be excluded, highlighting that even bigger investigations are needed.
In an associated report published this month in Hepatology, Dr. Mary Rinella with Northwestern University Medical School in Chicago, Illinois explained:
“The study by Bhala and colleagues expands our knowledge of the natural history of NAFLD and NASH. While HCC was not surprisingly higher in untreated patients with HCV compared to NAFLD, this study highlights the potential of HCC development in non-cirrhotic patients with HCV and NASH. If patients with NAFLD or HCV are likely to develop HCC before the development of cirrhosis, this has tremendous implications for how and when liver cancer screening should begin in patients with liver disease.”
Written by Grace Rattue