Does MetS induce fibrosis progression/regression?

Metabolic syndrome (MetS) appears to contribute to greater histological severity in patients with nonalcoholic fatty liver disease (NAFLD) but does not seem to influence disease progression or regression, according to a study. 

A total of 452 patients (mean age 51 years, one-third male, 85 percent White) were included in this post hoc analysis of a multicentre prospective cohort study, with a median follow-up of 4.3 years. 

Compared with those without MetS, patients with MetS, large waist circumference, and impaired glucose tolerance/diabetes had worse ballooning and fibrosis scores, as well as a higher prevalence of definite nonalcoholic steatohepatitis at baseline.  

MetS showed no significant relationship with fibrosis progression or regression. In contrast, impaired glucose tolerance/diabetes correlated with an elevated risk of fibrosis progression (adjusted hazard ratio [aHR], 1.61, 95 percent confidence interval [CI], 1.11‒2.34), while hypertension correlated with a reduced risk (aHR, 0.64, 95 percent CI, 0.43‒0.96). 

This study used the noninterventional registry of the Nonalcoholic Steatohepatitis Clinical Research Network (2002‒2022) and included patients aged ≥18 years with biopsy-proven NAFLD. Outcomes assessed were progression/regression of histology defined by changes in NAFLD Activity Score, nonalcoholic steatohepatitis, or fibrosis. 

The investigators used Kaplan-Meier curves and log-rank test to compare the crude incidence rates among patients with vs without MetS. They also estimated the effects of MetS and its components on fibrosis progression/regression using Cox proportional hazard models.