Cited by 2,302Liver Disease Diagnosis and TreatmentLiver Diseases and ImmunityAlcohol Consumption and Health Effects

Long-term follow-up of patients with NAFLD and elevated liver enzymes

Ekstedt, Mattias, Franzén, Lennart E., Mathiesen, Ulrik L., Thorelius, Lars, Holmqvist, Marika, Bodemar, Göran, Kechagias, Stergios·2006·Hepatology

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver enzymes in patients of developed countries. We determined the long-term clinical and histological courses of such patients. In a cohort study, 129 consecutively enrolled patients diagnosed with biopsy-proven NAFLD were reevaluated. Survival and causes of death were compared with a matched reference population. Living NAFLD patients were offered repeat liver biopsy and clinical and biochemical investigation. Mean follow-up (SD) was 13.7 (1.3) years. Mortality was not increased in patients with steatosis. Survival of patients with nonalcoholic steatohepatitis (NASH) was reduced (P = .01). These subjects more often died from cardiovascular (P = .04) and liver-related (P = .04) causes. Seven patients (5.4%) developed end-stage liver disease, including 3 patients with hepatocellular carcinoma. The absence of periportal fibrosis at baseline had a negative predictive value of 100% in predicting liver-related complications. At follow-up, 69 of 88 patients had diabetes or impaired glucose tolerance. Progression of liver fibrosis occurred in 41%. These subjects more often had a weight gain exceeding 5 kg (P = .02), they were more insulin resistant (P = .04), and they exhibited more pronounced hepatic fatty infiltration (P = .03) at follow-up. In conclusion, NAFLD with elevated liver enzymes is associated with a clinically significant risk of developing end-stage liver disease. Survival is lower in patients with NASH. Most NAFLD patients will develop diabetes or impaired glucose tolerance in the long term. Progression of liver fibrosis is associated with more pronounced insulin resistance and significant weight gain.

Integrity signals

Registry

Crossref · 10.1002/hep.21327

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Ekstedt, M., Franzén, L. E., Mathiesen, U. L., Thorelius, L., Holmqvist, M., Bodemar, G., & Kechagias, S.
Affiliations
  • Linköping University Hospital (SE)
  • Örebro University Hospital (SE)
Corresponding author
Kechagias, Stergios
Venue
Hepatology
Published
2006-10
Volume
44
Issue
4
Pages
865-873
ISSN
0270-9139 (ISSN-L)
OpenAlex
W1969295126
Cited by
2,302
References
26
Citations by year
2026: 20 · 2025: 66 · 2024: 60 · 2023: 99 · 2022: 106 · 2021: 125 · 2020: 136 · 2019: 132 · 2018: 137 · 2017: 152 · 2016: 156 · 2015: 179 · 2014: 159 · 2013: 141 · 2012: 126
FWCI
58.82
Type
journal article
Language
en
Open access
closed
Locations
  • Hepatology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords
non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, elevated liver enzymes, long-term follow-up, mortality, end-stage liver disease, hepatocellular carcinoma, liver fibrosis progression, insulin resistance, weight gain, diabetes mellitus, impaired glucose tolerance, periportal fibrosis, liver histopathology
MeSH terms
Alkaline Phosphatase, Transaminases, Cardiovascular Diseases, Fatty Liver, Female, Follow-Up Studies, Humans, Liver, Liver Diseases, Male, Middle Aged, Prognosis, Cohort Studies, Survival Rate, Disease Progression

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review