Original articleSystematic reviews and meta-analysesFibrosis Progression in Nonalcoholic Fatty Liver vs Nonalcoholic Steatohepatitis: A Systematic Review and Meta-analysis of Paired-Biopsy Studies
Section snippets
Methods
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the process followed an a priori established protocol.14
Results
From a total of 1994 unique studies identified using the prespecified systematic search strategy, 11 observational studies were included in this analysis.7, 8, 12, 13, 22, 23, 24, 25, 26, 27, 28 Six studies were excluded owing to a lack of sufficient information to calculate the FPR despite the availability of paired liver biopsies. We were able to obtain additional information (which was not available in the published article) that was required to calculate the FPR by the presence of baseline
Discussion
Based on evidence derived from this systematic review and meta-analysis of paired liver biopsy studies, we show that both patients with NAFL and NASH may develop progressive liver fibrosis. The annual FPR in patients with NAFL vs NASH, with baseline stage 0 fibrosis, was 0.07 stages vs 0.14 stages, respectively, corresponding to an average progression of 1 stage over 14.3 vs 7.1 years, respectively. Among patients who developed progressive liver fibrosis on follow-up liver biopsy, we identified
Acknowledgments
The authors sincerely thank the following investigators for kindly sharing additional data from their cohort, which enabled this meta-analysis to be performed: Manel Abdelmalek, MD, MPH (Division of Gastroenterology/Hepatology, Duke University Medical Center, Durham, North Carolina); Henry Chan, MD (Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China); Stergio Kechagias, MD, PhD (Division of Gastroenterology and Hepatology, Linköping University,
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This article has an accompanying continuing medical education activity on page e40. Learning Objective–Upon completion of this activity, successful learners will be able to estimate rate of progression of fibrosis in patients with non-alcoholic fatty liver disease.
Conflicts of interest The authors disclose no conflicts.
Funding Supported in part by the American Gastroenterological Association Foundation–Sucampo–Association of Specialty Professors Designated Research Award in Geriatric Gastroenterology, a T. Franklin Williams Scholarship Award, Atlantic Philanthropies, Inc, the John A. Hartford Foundation, the Association of Specialty Professors, and National Institute of Health grants P30CA23100-28 and K23DK090303 (R.L.).