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Journal ArticleDOI

A systematic review of follow-up biopsies reveals disease progression in patients with non-alcoholic fatty liver

01 Sep 2013-Journal of Hepatology (Elsevier)-Vol. 59, Iss: 3, pp 550-556
TL;DR: A substantial proportion of patients with NAFL can progress towards well-defined NASH with bridging fibrosis, especially if metabolic risk factors deteriorate, and current monitoring practices of these patients should be revised.
About: This article is published in Journal of Hepatology.The article was published on 2013-09-01. It has received 417 citations till now. The article focuses on the topics: Fatty liver & Steatohepatitis.
Citations
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Journal ArticleDOI
TL;DR: The final purpose is to improve patient care and awareness of the importance of NAFLD, and to assist stakeholders in the decision-making process by providing evidence-based data, which also takes into consideration the burden of clinical management for the healthcare system.

3,117 citations

Journal ArticleDOI
TL;DR: Understanding of pathogenic mechanisms and clinical features of NAFLD is driving progress in therapeutic strategies now in clinical trials and the emerging targets for drug development that involve either single agents or combination therapies intended to arrest or reverse disease progression are discussed.
Abstract: There has been a rise in the prevalence of nonalcoholic fatty liver disease (NAFLD), paralleling a worldwide increase in diabetes and metabolic syndrome. NAFLD, a continuum of liver abnormalities from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH), has a variable course but can lead to cirrhosis and liver cancer. Here we review the pathogenic and clinical features of NAFLD, its major comorbidities, clinical progression and risk of complications and in vitro and animal models of NAFLD enabling refinement of therapeutic targets that can accelerate drug development. We also discuss evolving principles of clinical trial design to evaluate drug efficacy and the emerging targets for drug development that involve either single agents or combination therapies intended to arrest or reverse disease progression.

2,004 citations

Journal ArticleDOI
09 Jun 2015-JAMA
TL;DR: How to identify patients with nonalcoholic fatty liver disease at greatest risk of non Alcoholic steatohepatitis and cirrhosis is illustrated and the role and limitations of current diagnostics and liver biopsy are discussed to provide an outline for the management of patients across the spectrum of non alcoholic fatty Liver disease.
Abstract: Importance Nonalcoholic fatty liver disease and its subtype nonalcoholic steatohepatitis affect approximately 30% and 5%, respectively, of the US population. In patients with nonalcoholic steatohepatitis, half of deaths are due to cardiovascular disease and malignancy, yet awareness of this remains low. Cirrhosis, the third leading cause of death in patients with nonalcoholic fatty liver disease, is predicted to become the most common indication for liver transplantation. Objectives To illustrate how to identify patients with nonalcoholic fatty liver disease at greatest risk of nonalcoholic steatohepatitis and cirrhosis; to discuss the role and limitations of current diagnostics and liver biopsy to diagnose nonalcoholic steatohepatitis; and to provide an outline for the management of patients across the spectrum of nonalcoholic fatty liver disease. Evidence Review PubMed was queried for published articles through February 28, 2015, using the search termsNAFLD and cirrhosis, mortality, biomarkers,andtreatment. A total of 88 references were selected, including 14 randomized clinical trials, 19 cohort or case-control studies, 1 population-based study, 2 practice guidelines, 7 meta-analyses, 43 classified as other, and 2 webpages. Findings Sixty-six percent of patients older than 50 years with diabetes or obesity are thought to have nonalcoholic steatohepatitis with advanced fibrosis. Even though the ability to identify the nonalcoholic steatohepatitis subtype within those with nonalcoholic fatty liver disease still requires liver biopsy, biomarkers to detect advanced fibrosis are increasingly reliable. Lifestyle modification is the foundation of treatment for patients with nonalcoholic steatosis. Available treatments with proven benefit include vitamin E, pioglitazone, and obeticholic acid; however, the effect size is modest ( Conclusions and Relevance Between 75 million and 100 million individuals in the United States are estimated to have nonalcoholic fatty liver disease and its potential morbidity extends beyond the liver. It is important that primary care physicians, endocrinologists, and other specialists be aware of the scope and long-term effects of the disease. Early identification of patients with nonalcoholic steatohepatitis may help improve patient outcomes through treatment intervention, including transplantation for those with decompensated cirrhosis.

1,743 citations

Journal ArticleDOI
TL;DR: A panel of international experts from 22 countries propose a new definition of metabolic-dysfunction-associated fatty liver disease that is both comprehensive yet simple for the diagnosis of MAFLD and is independent of other liver diseases.

1,705 citations

Journal ArticleDOI
TL;DR: Liver biopsy gives a snapshot and not an insight into the dynamic changes during the process of fibrogenesis, so immunohistochemical evaluation of cellular markers such as smooth muscle actin expression for hepatic stellate cell activation, cytokeratin 7 for labeling ductular proliferation or CD34 for visualization of sinusoidal endothelial capillarization can provide additional ‘‘functional’’ information.

1,441 citations


Cites background from "A systematic review of follow-up bi..."

  • ...Histologic inflammation and maybe metabolic factors are associated with higher risk of fibrosis progression among patients with simple steatosis or steatohepatitis [230]....

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References
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Journal ArticleDOI
TL;DR: This is a practice guideline for clinicians rather than a review article and interested readers can refer to several comprehensive reviews published recently.

3,212 citations


"A systematic review of follow-up bi..." refers background in this paper

  • ...The present findings stress the need to revise current guidelines that do not recommend specific hepatic monitoring in NAFLD patients without NASH [2,19]....

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  • ...Indeed, NAFLD encompasses both steatohepatitis (NASH), considered the more aggressive form of the disease, and NAFL (non-alcoholic fatty liver) grouping isolated steatosis and steatosis with mild lobular inflammation alone [1,2]....

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Journal ArticleDOI
TL;DR: The outcome of cirrhosis and liver-related death is not uniform across the spectrum of nonalcoholic fatty liver, and poor outcomes are more frequent in patients in whom biopsies show ballooning degeneration and Mallory hyaline or fibrosis.

3,167 citations


"A systematic review of follow-up bi..." refers background in this paper

  • ...Later reports showed that patients with bland steatosis or steatosis and nonspecific inflammation have the same survival as the age- and sex-matched general population [14], while patients with steatohepatitis have increased liver-related mortality [15]....

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Journal ArticleDOI
TL;DR: Mortality among community-diagnosed NAFLD patients is higher than the general population and is associated with older age, impaired fasting glucose, and cirrhosis, although the absolute risk is low.

2,681 citations

Journal ArticleDOI
TL;DR: The presence of multiple metabolic disorders is associated with a potentially progressive, severe liver disease and the increasing prevalence of obesity, coupled with diabetes, dyslipidemia, hypertension, and ultimately the metabolic syndrome puts a very large population at risk of forthcoming liver failure in the next decades.

2,538 citations


"A systematic review of follow-up bi..." refers result in this paper

  • ...They were less insulin resistant as measured by surrogate markers and related clinical phenotypes, thus confirming observations made by others a decade ago [16]....

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