Key result
NASH carries increased mortality and represents a distinct clinical entity from simple steatosis.
Why the study?
Non-alcoholic fatty liver disease encompasses a spectrum from simple steatosis to NASH, with differing pathophysiology, diagnosis, management, and prognosis that require clarification.
Simple steatosis and NASH should be considered two distinct entities due to differences in pathophysiology, diagnosis, management, and prognosis, with NASH conveying increased mortality.
Distinguishing simple steatosis from NASH may refine prognosis assessment; leaves open whether management should differ in routine practice.
Non-alcoholic fatty liver disease affects nearly 30% of Americans. A histopathological spectrum exists from simple steatosis to NASH which may progress to cirrhosis and HCC. NASH is currently the third most common indication for liver transplant with increasing incidence. Steatosis can be considered the hepatic manifestation of the metabolic syndrome as insulin resistance is a major risk factor for its development. While liver biopsy is the gold standard for diagnosis, non-invasive methods are currently being developed to appropriately determine who needs histologic evaluation. Management focuses on mitigation of risk factors, since targeted therapies to halt progression of fibrosis have not been validated. Simple steatosis does not affect overall survival, but NASH conveys increased mortality. Because of this, non-invasive strategies to diagnose patients and management algorithms are needed. This review supports the definitions of simple steatosis and NASH as two distinct entities based on pathophysiology, diagnosis, management, and prognosis.
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Fielding et al. (2014) conducted a review in Non-alcoholic fatty liver disease (NAFLD). Simple steatosis and non-alcoholic steatohepatitis (NASH) are two distinct entities based on pathophysiology, diagnosis, management, and prognosis, with NASH conveying increased mortality.
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