Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease

Brent A. Neuschwander-Tetri, Jeanne M. Clark, Nathan M. Bass, Mark L. Van Natta, Aynur Unalp-Arida, James Tonascia, Claudia O. Zein, Elizabeth M. Brunt, David E. Kleiner, Arthur J. McCullough, Arun J. Sanyal, Anna Mae Diehl, Joel E. Lavine, Naga Chalasani, Kris V. Kowdley

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Abstract

The Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) was formed to conduct multicenter studies on the etiology, contributing factors, natural history, and treatment of nonalcoholic steatohepatitis (NASH). The aim of this study was to determine the associations of readily available demographic, clinical, and laboratory variables with the diagnosis of NASH and its key histological features, and determine the ability of these variables to predict the severity of nonalcoholic fatty liver disease (NAFLD). A total of 1266 adults were enrolled in NASH CRN studies between October 2004 and February 2008, of whom 1101 had available liver histology. The median age was 50 years; 82% were white and 12% Hispanic. The median body mass index was 33 kg/m 2; 49% had hypertension and 31% had type 2 diabetes. On liver biopsy, 57% were judged to have definite NASH and 31% bridging fibrosis or cirrhosis. Using data from the 698 patients with liver biopsies within 6 months of clinical data, patients with definite NASH were more likely to be female and have diabetes, higher levels of aspartate and alanine aminotransferases, alkaline phosphatase, gamma glutamyl transpeptidase, and homeostasis model assessment of insulin resistance (HOMA-IR). Progressive models for predicting histological diagnoses performed modestly for predicting steatohepatitis or ballooning (area under receiver operating characteristic curves [AUROC] ranged from 0.70-0.79), and better for advanced fibrosis (AUROC 0.73-0.85). Conclusion: Readily available clinical and laboratory variables can predict advanced fibrosis in adults with NAFLD, but additional information is needed to reliably predict the presence and severity of NASH. Prospective studies of this well-characterized population and associated tissue bank samples offer a unique opportunity to better understand the cause and natural history of NAFLD and develop more precise means for noninvasive diagnosis.

Original languageEnglish
Pages (from-to)913-924
Number of pages12
JournalHepatology
Volume52
Issue number3
DOIs
StatePublished - Sep 2010

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Fibrosis
ROC Curve
Liver
Non-alcoholic Fatty Liver Disease
Tissue Banks
Biopsy
gamma-Glutamyltransferase
Fatty Liver
Aspartate Aminotransferases
Natural History
Alanine Transaminase
Hispanic Americans
Research
Type 2 Diabetes Mellitus
Multicenter Studies
Alkaline Phosphatase
Insulin Resistance
Histology
Body Mass Index
Homeostasis

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)

Cite this

Neuschwander-Tetri, B. A., Clark, J. M., Bass, N. M., Van Natta, M. L., Unalp-Arida, A., Tonascia, J., ... Kowdley, K. V. (2010). Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease. Hepatology, 52(3), 913-924. https://doi.org/10.1002/hep.23784

Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease. / Neuschwander-Tetri, Brent A.; Clark, Jeanne M.; Bass, Nathan M.; Van Natta, Mark L.; Unalp-Arida, Aynur; Tonascia, James; Zein, Claudia O.; Brunt, Elizabeth M.; Kleiner, David E.; McCullough, Arthur J.; Sanyal, Arun J.; Diehl, Anna Mae; Lavine, Joel E.; Chalasani, Naga; Kowdley, Kris V.

In: Hepatology, Vol. 52, No. 3, 09.2010, p. 913-924.

Research output: Contribution to journalArticle

Neuschwander-Tetri, BA, Clark, JM, Bass, NM, Van Natta, ML, Unalp-Arida, A, Tonascia, J, Zein, CO, Brunt, EM, Kleiner, DE, McCullough, AJ, Sanyal, AJ, Diehl, AM, Lavine, JE, Chalasani, N & Kowdley, KV 2010, 'Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease', Hepatology, vol. 52, no. 3, pp. 913-924. https://doi.org/10.1002/hep.23784
Neuschwander-Tetri BA, Clark JM, Bass NM, Van Natta ML, Unalp-Arida A, Tonascia J et al. Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease. Hepatology. 2010 Sep;52(3):913-924. https://doi.org/10.1002/hep.23784
Neuschwander-Tetri, Brent A. ; Clark, Jeanne M. ; Bass, Nathan M. ; Van Natta, Mark L. ; Unalp-Arida, Aynur ; Tonascia, James ; Zein, Claudia O. ; Brunt, Elizabeth M. ; Kleiner, David E. ; McCullough, Arthur J. ; Sanyal, Arun J. ; Diehl, Anna Mae ; Lavine, Joel E. ; Chalasani, Naga ; Kowdley, Kris V. / Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease. In: Hepatology. 2010 ; Vol. 52, No. 3. pp. 913-924.
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