Abstract

Yang et al1Yang J.D. et al.Clin Gastroenterol Hepatol. 2017; 15 (1271–31 e2)Google Scholar on behalf of the Nonalcoholic Steatohepatitis (NASH) Clinical Research Network reviewed the liver biopsies of premenopausal women with NASH. They have demonstrated high Nonalcoholic Fatty Liver Disease Activity Score (NAS) scores in these women compared with men or postmenopausal women. The authors noted that this population of premenopausal women exhibits a better prognosis than postmenopausal women or men, while showing that the fibrosis scores in the premenopausal cohort were lower as well. The NAS score, which evaluates steatosis, lobular inflammation, and ballooning hepatocyte degeneration, is the standard method of identifying NASH for clinical studies because of its reproducibility. However, the NAS score has been demonstrated to be inaccurate in any given patient for the diagnosis of NASH.2Brunt E.M. et al.Hepatology. 2011; 53: 810-820Google Scholar, 3Wong V.W.-S. et al.Aliment Pharmacol Ther. 2011; 34: 494-495Google Scholar, 4Hjelkrem M. et al.Aliment Pharmacol Ther. 2011; 34: 495-496Google Scholar Moreover, the NAS score been shown to be a weak surrogate for NASH prognosis.5Ekstedt M. et al.Scand J Gastroenterol. 2012; 47: 108-115Google Scholar, 6Sebastiani G. et al.PLoS One. 2015; 10: e0128774Google Scholar, 7Younossi Z.M. et al.Hepatology. 2011; 53: 1874-1882Google Scholar, 8Hannah Jr., W.N. et al.Gastroenterol Hepatol (N Y). 2016; 12: 756-763Google Scholar Histologically, hepatic fibrosis is the most predictive prognosticator.9Angulo P. et al.Gastroenterology. 2015; 149 (e10): 389-397Google Scholar, 10Ekstedt M. et al.Hepatology. 2015; 61: 1547-1554Google Scholar The strongest prognostic finding of the 3 elements of the NAS score was ballooning degeneration, which ironically is underweighted when compared with fat or lobular inflammation in the NAS score.9Angulo P. et al.Gastroenterology. 2015; 149 (e10): 389-397Google Scholar Consequently, we think that using the adjective “worse” is misleading in this context. The present study indeed demonstrates once again that fibrosis and not the NAS score is the better prognosticator in NASH. Patient Sex, Reproductive Status, and Synthetic Hormone Use Associate With Histologic Severity of Nonalcoholic SteatohepatitisClinical Gastroenterology and HepatologyVol. 15Issue 1PreviewSex and sex hormones can affect responses of patients with nonalcoholic fatty liver disease (NAFLD) to metabolic stress and development of hepatocyte injury and inflammation. Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 16Issue 10PreviewWe appreciate the letter from Dr Smith et al regarding our recent publication.1,2 We agree that the most significant histologic feature of nonalcoholic fatty liver disease (NAFLD) is the degree of fibrosis, which predicts long-term clinical outcome in patients with NAFLD3–5 We also agree that the NAFLD activity score (NAS), although useful for clinical research in nonalcoholic steatohepatitis, is not an ideal prognosticator of outcomes for patients with NAFLD.3–5 The NAS was developed in 2005 to provide a standardized scoring system for clinical trials, and was created to encompass the full spectrum of NAFLD histology in both adults and children. Full-Text PDF

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