The authors state that "Obesity and the metabolic syndrome are the leading public health problems of our time." One of the consequences of the metabolic syndrome is the development of nonalcoholic steatohepatitis (NASH). It has been estimated that 3% of the population has NASH and NASH can progress to cirrhosis in up to 20% of patients. Because of the national epidemic of obesity, especially in children, the health care burden related to cirrhosis caused by NASH will continue to increase.

This trial compared a group of 152 patients with cirrhosis due to NASH with 150 patients with cirrhosis due to hepatitis C virus (HCV) infection. All patients were followed according to standard of care without any experimental therapies for NASH until they underwent liver transplantation or died. The HCV patients were used as a matched control.

Over 10 years, 29 patients with NASH and 44 patients with HCV died (p=0.04). Sepsis accounted for the majority of deaths in each group and was often associated with liver failure. NASH patients had a higher cardiac mortality ( 8 patients vs 1 patient, p<0.03). Fewer NASH patients developed ascites (14 vs 40, p<0.006) and hepatocellular carcinoma (10 vs 25, p<0.01).

This report is the largest prospective study of the natural history of cirrhosis due to NASH with greater than 10 years of follow-up.