Slow disease progression seen in people with NAFLD

A 23-year longitudinal follow-up in a population-based cohort has shown a slowly progressive trend in nonalcoholic fatty liver disease (NAFLD), with liver-related outcomes affecting only a small number of people, reports a recent study.

In this retrospective study, the authors prospectively collected data in a medical record linkage system, including all adults diagnosed with NAFLD between 1996 and 2016 by clinical, biochemical, and radiological criteria in Minnesota, US, and followed until 2019.

An individual medical record review ascertained and validated all liver-related outcomes and death. Using multistate modeling, the authors evaluated time and risk of progression from NAFLD to cirrhosis to decompensation and death.

Overall, 5,123 individuals with NAFLD (median age 52 years, 53 percent women) were followed for a median of 6.4 years. The risk of progression was 3 percent in 15 years from NAFLD to cirrhosis, 33 percent in 4 years from compensated cirrhosis to first decompensation, and 48 percent in 2 years from first decompensation to ≥2 decompensations.

The factors significantly and independently associated with decompensation were albumin, bilirubin, nonbleeding oesophageal varices, and diabetes. A total of 575 deaths occurred, of which 6 percent were liver-related.

“Therapeutic trials in compensated cirrhosis would require enrolment of a minimum of 2,886 individuals followed for >2 years to detect at least a 15-percent relative decrease in liver-related endpoints,” the authors said.

“Large sample sizes and long follow-up are required to detect reductions in liver-related endpoints in clinical trials,” they added.