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The article comments on a study by L. A. Adams and colleagues to determine the natural history of non-alcoholic fatty liver disease (NAFLD) in community-based patients in Minnesota. The authors were correct in clarifying that their data were more representative of the general population than past studies and that the mortality rate from liver disease was smaller in cohorts from hepatology centers.

The article presents comments on a clinical study to assess the effect of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) on survival in a large number of patients. They found that mortality was increased by 34% in NAFLD and that age, IFG, and cirrhosis were predictors of mortality. 13 patients developed liver-related complications. The authors rightfully pointed out that their data were more representative of the general population than previous reports and that the mortality rate from liver disease was lower than in cohorts from hepatology centers. First, the cohort consisted of 420 patients, although greater than 42 000 patients may be affected by NAFLD/NASH, based on the postulated prevalence of 34% in the population of 124 000 persons in Olmsted county. A question that remains unanswered for the internist and general practitioner is what to do with the patient with marker-negative liver disease who is suspected of having NAFLD/NASH.