ArticleHepatology (Baltimore, Md.)2020
Risk of Cirrhosis and Hepatocellular Cancer in Patients With NAFLD and Normal Liver Enzymes.
Article in Hepatology (Baltimore, Md.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
42 citing papers in PubMed, 2 syntheses or guidelines pooled it, 71 citations in OpenAlex.
- Non-invasive biomarkers prognostic of decompensation events in NASH cirrhosis: a systematic literature review.Journal of molecular medicine (Berlin, Germany) · 2024Pooled it
- Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease.Gastroenterology · 2021Guideline
- Risk of Hepatocellular Carcinoma or Hepatic Decompensation Associated With Steatotic Liver Disease in People With and Without HIV.Open forum infectious diseases · 2026Article
- Digital quality measure of potentially avoidable emergency presentations among patients with colorectal cancer.BMJ quality & safety · 2026Article
- Risk Assessment and Prediction of Hepatocellular Carcinoma in Noncirrhotic Metabolic Dysfunction-Associated Steatotic Liver Disease.International journal of molecular sciences · 2026Review
- Metabolic dysfunction-associated steatotic liver disease in Egypt: Epidemiology, risk factors and management challenges.World journal of gastroenterology · 2025Review
- Liver fibrosis with persistently normal alanine transaminase levels exhibits a distinct treatment response in MASLD.BMJ open gastroenterology · 2025Article
- Screening for metabolic-associated fatty liver disease in type 2 diabetes patients using non-invasive scores and ultrasound: a cross-sectional study in Egypt.BMC gastroenterology · 2025Article
- Evolving epidemiology of HCC in Spain.JHEP reports : innovation in hepatology · 2025Article
- Metabolic dysfunction-associated steatotic liver disease and its associated health risks.Journal of the Chinese Medical Association : JCMA · 2025Review
- Contemporary epidemiology of hepatocellular carcinoma: understanding risk factors and surveillance strategies.Journal of the Canadian Association of Gastroenterology · 2024Review
- Incidence rates of hepatocellular carcinoma based on risk stratification in steatotic liver disease for precision medicine: A real-world longitudinal nationwide study.PLoS medicine · 2024Article
- Controlled attenuation parameter (CAP): the clinical value based on MRI-PDFF in children with obesity.Journal of pediatric endocrinology & metabolism : JPEM · 2024Article
- Hepatocellular carcinoma surveillance - utilization, barriers and the impact of changing aetiology.Nature reviews. Gastroenterology & hepatology · 2023Review
- MAFLD: an optimal framework for understanding liver cancer phenotypes.Journal of gastroenterology · 2023Review
- New-Onset Age of Nonalcoholic Fatty Liver Disease and Cancer Risk.JAMA network open · 2023Article
- Review
- Nonalcoholic steatohepatitis-related hepatocellular carcinoma: pathogenesis and treatment.Nature reviews. Gastroenterology & hepatology · 2023Review
- Daily aspirin associated with a reduced risk of hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: a population-based cohort study.EClinicalMedicine · 2023Article
- Screening for At-Risk Nonalcoholic Fatty Liver Disease in the Primary Care Setting.Seminars in liver disease · 2023Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
aimsThe long-term risk of disease for patients with nonalcoholic fatty liver disease (NAFLD) in the absence of elevated enzymes is unclear. We conducted a retrospective cohort study using the Corporate Data Warehouse of the Veterans Health Administration. APPROACH AND
resultsWe classified patients into three groups: patients with steatosis/normal alanine aminotransferase (ALT), steatosis/elevated ALT, and no steatosis/normal ALT. We examined incidence rates for cirrhosis and hepatocellular carcinoma (HCC) and conducted cause-specific hazard models to evaluate the risk of cirrhosis and HCC. We identified 3,522 patients with steatosis/normal ALT, 15,419 patients with steatosis/elevated ALT, and 9,267 patients with no steatosis/normal ALT. The mean age in each group was 58.9, 54.7 and 59.3 years, respectively; over 90% were men. Compared to patients with hepatic steatosis/normal ALT, those with steatosis/elevated ALT were younger and more likely to be obese (both P < 0.01). In patients with steatosis/normal ALT, the incidence rates of cirrhosis and HCC were 1.22 (95% confidence interval [CI]: 0.83-1.74) and 0.20 (95% CI: 0.06-0.46) per 1,000 person-years, respectively; this was lower than in patients with steatosis/elevated ALT (cirrhosis: 3.85; 95% CI: 3.50-4.23, and HCC: 0.37; 95% CI: 0.26-0.49). Patients with steatosis/elevated ALT had a higher risk of developing cirrhosis (adjusted hazard ratio: 3.37; 95% CI: 2.34-4.86; P < 0.01) than patients with steatosis/normal ALT; they also had a higher risk of HCC, although it did not reach statistical significance (hazard ratio: 2.07; 95% CI: 0.82-5.28; P = 0.13). The risk of cirrhosis and HCC in patients with steatosis/normal ALT and those without steatosis was not significantly different.
conclusionsPatients with hepatic steatosis with persistently normal ALT are at lower risk for cirrhosis compared to those with steatosis and elevated ALT and not different from the risk in a clinical cohort without hepatic steatosis.
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