Of the 47 in the latter group, 16 died before 1991, when such testing became generally available in Sweden. Of these 47 deceased subjects with NAFLD, two had been tested and were found to be negative for hepatitis C virus. No one in this group had any medical history of intravenous drug abuse or blood transfusions; nor did any exhibit the liver inflammation with portal infiltrates indicative of hepatitis C virus infection. All Swedish residents

are assigned a unique 10-digit national registration number, and these identification numbers are recorded in the nationwide and virtually complete Cause of Death Registry.12 Through selleck this registry, information concerning all deaths during the study period (1980 to July 9, 2008), including dates and causes of death (coded according to the International Classifications of Diseases versions 8, 9, and 1013–15) could be obtained. Similarly, through the national and continuously updated Population Registry, individuals still alive and residing in Sweden could

be identified, so that the follow-up was complete. On an outpatient basis, liver biopsies had been performed on all of the subjects percutaneously with a 1.6-mm Menghini-type needle. All of these biopsies were reevaluated employing a modern classification by two of the authors (C.S. and R.H.), as well as by Selleck NVP-LDE225 a third reference person (H.G.), all of whom were blinded to the patient details. Liver histology was scored in accordance with the system developed by Kleiner and Brunt et al.16 A classification of NASH was made on the basis of steatosis, lobular inflammation, and ballooning degeneration, and fibrosis was scored to determine the stage (progression) of this condition.

For grading disease activity in connection with chronic hepatitis, we used the scoring system developed by Batts and Ludwig.17 Iron content was evaluated according to Scheuer18 as no, weak, moderate, or intense staining, and localization predominantly in Kupffer cells or in hepatocytes. To assess the relative risk of death, we employed standardized O-methylated flavonoid mortality ratios (SMR), that is, the ratio between the observed numbers of deaths in the cohort compared with the number expected on the basis of mortality rates for the general population. The expected numbers of deaths were calculated by adding all person-years accumulated in the cohort into strata (sex, age [in 5-year groups) and calendar year of follow-up [in 5-year intervals]) and then multiplying the stratum-specific person-years by the corresponding stratum-specific incidence rates for the entire Swedish population. Ninety-five percent confidence intervals (CI) were calculated assuming that the observed events followed a Poisson distribution. Follow-up began at the date of the initial liver biopsy and ended on July 9, 2008, or, if earlier, the date of death. Kaplan-Meier curves are used to depict the mortality in the cohort graphically. All analyses were conducted using SAS statistical software.