Our research purposes are to further characterize the natural history of NAFLD, identify factors that influence the progression of NAFLD, and to develop and validate diagnostic methods for NAFLD.
Accumulation of lipids (steatosis) is the most common pathologic hepatic manifestation and is present in up to 30% of the general population. In the majority of individuals with hepatic steatosis the underlying cause is NAFLD, which is considered the hepatic manifestation of the metabolic syndrome. NAFLD has until recently been considered a harmless condition but studies from our group and other researchers have shown that NAFLD is a progressive disease in some individuals.
In a follow-up study on patients with histopathologically confirmed NAFLD our group was able to show that increased mortality was mainly due to cardiovascular disease. Moreover, we showed that the risk of developing decompensated liver cirrhosis was approximately 5%. Recently we have shown that liver fibrosis but not inflammation or hepatocyte degeneration is associated with increased cardiovascular death and future development of liver-related complications. We have also reported that stage of fibrosis predicts time to development of severe liver disease.
To gain better understanding of the clinical and histopathological course of NAFLD, patients are currently re-evaluated and undergo clinical examination, imaging studies and repeat liver biopsy. We are aiming at evaluating factors associated with future risk of fibrosis progression with special interest to alcohol consumption, weight changes, metabolic profile, hepatic iron content and pharmacological treatment.
Currently, a liver biopsy remains necessary for grading and staging of NAFLD. However, the procedure to obtain a liver biopsy is invasive and associated with discomfort and significant complications are encountered in some cases. Current research therefore also focuses on non-invasive methods for grading and staging of NAFLD.
In cooperation with researchers at the Center for Medical Image Science and Visualization (CMIV) our group is studying whether magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in combination with various serum markers can replace liver biopsy for grading and staging of NAFLD. Recently we showed that more patients with steatosis can be reliably diagnosed non-invasively with MRS if a lower threshold is used as cut-off.