Journal
JOURNAL OF HEPATOLOGY
Volume 41, Issue 5, Pages 751-757Publisher
ELSEVIER
DOI: 10.1016/j.jhep.2004.07.010
Keywords
non-alcoholic steatohepatitis; silent-non-alcoholic steatohepatitis; obesity; metabolic-syndrome; ballooning; glycogenated-nuclei
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Background/Aims: We studied the prevalence of non-alcoholic fatty liver disease and non-alcoholic-steatobepatitis in patients with metabolic-syndrome but normal liver enzymes. The histological findings of patients with normal liver enzymes and non-alcoholic-steatohepatitis were compared with those of a control-group with persistently abnormal liver enzymes. Methods: Patients presenting with normal liver enzymes were enrolled in the study and underwent liver biopsy. Prevalence of non-alcoholic-steatohepatitis and risk factors for fibrosis and cirrhosis were evaluated. Data from a control-group with non-alcoholic-steatohepatitis and abnormal liver enzymes were used to compare the histological findings. Results: Fifty-eight of the 80 patients enrolled had varying degrees of non-alcoholic steatohepatitis, of these 26 had fibrosis and 8 silent cirrhosis. The association of metabolic-syndrome, female-sex, a long-history of obesity and body mass index > 45 were considered to be independent risk-factors for fibrosis. Comparing the histological findings of cases and controls we found a similar severity of steatosis and fibrosis, with a greater prevalence of ballooning degeneration and glycogenated-nuclei rather than lobular-inflammation. Conclusions: In the subjects selected according to our criteria, liver enzyme levels could not be used as surrogate markers of non-alcoholic-steatohepatitis. Histological hallmarks of patients with metabolic-syndrome, normal liver enzymes and non-alcoholic-steatohepatitis consist to a lesser degree of lobular-inflammation and a more severe ballooning and glycogenated-nuclei. (C) 2004 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.
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