NAFLD is closely related to features of the metabolic syndrome including type 2 diabetes. P. Nasr et al. (Linköping University, Sweden) investigated the importance of the amount of liver fat on mortality and the risk of developing type 2 diabetes.
In 129 patients with biopsy proven NAFLD prospectively re-evaluated on two occasions, the severity of hepatic fat accumulation was able to predict both T2D development and the overall survival. Automated quantification of hepatic fat by stereological point counting (SPC) predicted these outcomes independently of adiposity, histological steatosis grade, and also of hepatic inflammation and fibrosis.
As stated in the accompanying editorial by Luca Valenti and Serena Pelusi (Milan, Italy), limitations of this study include the monocentric design, limited sample size, and lack of independent replication. For L. Valenti and S. Pelusi, these results “suggest that quantitative assessment of liver fat is superior to qualitative histological evaluation of steatosis and of the presence of NASH, which is currently the standard of diagnostic sub-classification of NAFLD, and may likely represent a useful prognostic marker for mortality and extra-hepatic complications of FLD.”