Even mild fatty liver disease may raise early death risk

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Non-alcoholic fatty liver disease, NAFLD, affects nearly one in four adults in Europe and the U.S.

Earlier research has shown an increased risk of death in patients with NAFLD and advanced fibrosis or cirrhosis.

In a new study, researchers found that mortality increases with disease severity, but even mild fatty liver disease is linked to higher mortality.

The research was conducted by a team at Karolinska Institutet in Sweden and Massachusetts General Hospital in the U.S.

Non-alcoholic fatty liver disease is often caused by obesity and affects nearly 25 percent of U.S. and European adults. It represents the most common cause of chronic liver disease in Western countries.

Small clinical studies have found that among patients with NAFLD, advanced liver fibrosis is the most important histological predictor of mortality, but until now, population-level data have been missing from cohorts with liver histology.

In the study, the team matched 10,568 individuals with biopsy-confirmed NAFLD to general population controls through Sweden’s comprehensive, nationwide registers.

They found that all stages of NAFLD were linked to excess mortality risk, even early stages of the disease.

This risk was driven primarily by deaths from extra-hepatic cancer and cirrhosis, while the risks of cardiovascular mortality or hepatocellular carcinoma (HCC) mortality were relatively modest.

Patients with NAFLD had a 93% increased risk of all-cause death, but the numbers varied with disease severity.

The risk increased progressively from the mildest form of NAFLD (simple steatosis) to non-fibrotic steatohepatitis (NASH), to non-cirrhotic fibrosis, and to severe NAFLD with liver cirrhosis.

This is the first nationwide study with detailed liver histology data to confirm that NAFLD contributes to an increased risk of all-cause mortality.

These findings can be used to develop more targeted interventions designed to reduce mortality, in patients with NAFLD.

One author of the study is Tracey G. Simon, researcher and hepatologist at Massachusetts General Hospital.

The study is published in Gut.

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