Kaumudee Pattnaik1, Pallavi Bhuyan1, Ayaskant Singh2, Shivaram P Singh3, Preetam Nath4, Sanjib Kar5, Bijay Misra6, Jayashree Rath7. 1. Department of Pathology, SCB Medical College, Cuttack, Odisha, India. 2. Department of Gastroenterology, IMs and SUm Hospital, Bhubaneswar, Odisha, India. 3. Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India. 4. Department of Gastroenterology, KIMs, Bhubaneswar, India. 5. Gastro Liver Care, Cuttack, India. 6. Institute of Gastro and Kidney Care Hospital, Bhubaneswar, India. 7. Department of Pathology, KIMs, Bhubaneswar, India.
Abstract
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is emerging as an important cause of liver disease in India. NAFLD is characterized by hepatic steatosis in absence of a significant alcohol use or other known liver disease. Non-alcoholic steatohepatitis (NASH) is a progressive form of NAFLD which deserves particular attention because it is more prone for development of fibrosis. Liver biopsy is the gold standard for diagnosis of NASH by evaluating necroinflammatory activity and stages of fibrosis. The aim of the study was to analyze liver biopsy specimens and identify risk factors associated with fibrosis in patients of NAFLD in eastern coastal India. METHODS: A total of 216 subjects with fatty liver in ultrasonography (USG) were selected for needle biopsy. Those NAFLD cases showing fibrosis in biopsy were analyzed for risk factors association. RESULTS: Definite NASH was diagnosed in 50 (23.14%), borderline NASH in 66 (30.55%) and not NASH in 100 (46.39%) of cases. Those patients with fibrosis (22%) were taken as cases and those without fibrosis (78%) were taken as controls for risk factor analysis. Age > 40 [odds ratio (OR) 2.01 (1.09-4.04)], female gender [OR 2.74 (1.24-6.05)], body mass index (BMI) > 23 [OR 15.36 (4.59-51.37)] and moderate fatty change in USG [OR 1.89 (1.01-3.62)] were observed as risk factors for progression to fibrosis in NAFLD cases. CONCLUSION: Older age, females, obesity and moderate fatty liver on USG are risk factors for development of fibrosis in patients with NAFLD. Patients with these risk factors should be selected for liver biopsy and to be kept for close follow-up.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is emerging as an important cause of liver disease in India. NAFLD is characterized by hepatic steatosis in absence of a significant alcohol use or other known liver disease. Non-alcoholic steatohepatitis (NASH) is a progressive form of NAFLD which deserves particular attention because it is more prone for development of fibrosis. Liver biopsy is the gold standard for diagnosis of NASH by evaluating necroinflammatory activity and stages of fibrosis. The aim of the study was to analyze liver biopsy specimens and identify risk factors associated with fibrosis in patients of NAFLD in eastern coastal India. METHODS: A total of 216 subjects with fatty liver in ultrasonography (USG) were selected for needle biopsy. Those NAFLD cases showing fibrosis in biopsy were analyzed for risk factors association. RESULTS: Definite NASH was diagnosed in 50 (23.14%), borderline NASH in 66 (30.55%) and not NASH in 100 (46.39%) of cases. Those patients with fibrosis (22%) were taken as cases and those without fibrosis (78%) were taken as controls for risk factor analysis. Age > 40 [odds ratio (OR) 2.01 (1.09-4.04)], female gender [OR 2.74 (1.24-6.05)], body mass index (BMI) > 23 [OR 15.36 (4.59-51.37)] and moderate fatty change in USG [OR 1.89 (1.01-3.62)] were observed as risk factors for progression to fibrosis in NAFLD cases. CONCLUSION: Older age, females, obesity and moderate fatty liver on USG are risk factors for development of fibrosis in patients with NAFLD. Patients with these risk factors should be selected for liver biopsy and to be kept for close follow-up.
Entities:
Keywords:
ALK, alkaline phosphatase; ALT, alanine transferase; AST, aspartate transferase; BMI, body mass index; CI, confidence interval; FBS, fasting blood sugar; H&E, Hematoxylin & Eosin; HDL, high density cholesterol; IR, insulin resistance; LDL, low density cholesterol; NAFLD; NAFLD, non-alcoholic fatty liver disease; NAS, NAFLD Activity Score; NASH, non-alcoholic steatohepatitis; OR, odds ratio; PPBS, post-prandial blood sugar; Tc, total cholesterol; Tg, triglyceride; USG, ultrasonography; fibrosis; liver biopsy; risk factors; ultrasonography
Authors: V Ratziu; P Giral; F Charlotte; E Bruckert; V Thibault; I Theodorou; L Khalil; G Turpin; P Opolon; T Poynard Journal: Gastroenterology Date: 2000-06 Impact factor: 22.682
Authors: Shivakumar Chitturi; Shehan Abeygunasekera; Geoffrey C Farrell; Jane Holmes-Walker; Jason M Hui; Caroline Fung; Rooshdiya Karim; Rita Lin; Dev Samarasinghe; Christopher Liddle; Martin Weltman; Jacob George Journal: Hepatology Date: 2002-02 Impact factor: 17.425
Authors: Steven Woon Choy Tsang; Wing Fung Ng; Brian Ping Ying Wu; David Alan Chow; Eric Ting Ho Li; Tak Cheung Wong Journal: J Gastroenterol Hepatol Date: 2006-01 Impact factor: 4.029
Authors: David E Kleiner; Elizabeth M Brunt; Mark Van Natta; Cynthia Behling; Melissa J Contos; Oscar W Cummings; Linda D Ferrell; Yao-Chang Liu; Michael S Torbenson; Aynur Unalp-Arida; Matthew Yeh; Arthur J McCullough; Arun J Sanyal Journal: Hepatology Date: 2005-06 Impact factor: 17.425