2007, Number 1
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Ann Hepatol 2007; 6 (1)
Fatty liver: Experience from western India
Amarapurkar A, Ghansar T
Language: English
References: 23
Page: 37-40
PDF size: 70.38 Kb.
Text Extraction
Introduction: Incidence of fatty liver is rising all over the world. Non alcoholic Steatohepatitis which is a subset of fatty liver disease has become a major concern since it is known to progress to liver cirrhosis. Obesity and diabetes mellitus are considered to be the important risk factors for nonalcoholic steatohepatitis. However fatty liver is also seen in non obese and non diabetic individuals. The epidemiology of fatty liver disease slightly differs in different countries, specially where various infections are more prevalent.
Aim: To determine various risk factors responsible for steatosis and to assess severity of steatosis with fibrosis amongst various groups.
Material and methods: Total 1,230 adult autopsies were screened over the period of 4 years. Amongst them 195 cases showing fatty liver were included in the study. Different risk factors responsible for fatty liver were analyzed from the clinical data and laboratory findings obtained from hospital records. Liver histological sections were studied for the presence of steatosis, inflammation and fibrosis. These 3 histological parameters were compared amongst the risk factors.
Results: Alcoholism was found to be the commonest risk factor for staetosis followed by tuberculosis. Other risk factors were cardiac disorders, diabetes, hypertension, Hepatitis B & C infection, HIV and miscellaneous conditions. Overall prevalence of steatosis was found to be 15.8%. Steatosis, inflammation and fibrosis were more common in alcoholics. Tuberculosis was the second commonest risk factor, showed grade 2 to 3 steatosis however inflammation and fibrosis were significantly less in cases of tuberculosis. Findings in other risk factors were variable.
Conclusion: Overall prevalence of fatty liver in this autopsy study was found to be 15.8%. Alcoholism was the commonest risk factor followed by tuberculosis. Fibrosis was mainly observed in association with alcoholism as compared to other risk factors.
REFERENCES
Mofrad Ps, Contos MJ, Haque M, Sargeant C, Fisher RA, Luketic VA, Sterling RK, Shiffman ML, Stravitz RT, Sanyal AJ. Clinical and histological spectrum of non alcoholic fatty liver disease associated with normal ALT valves. Hepatology 2003; 37: 1286-92.
Brunt Em. Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 2001; 21: 3-16.
Wedemeyer H, Manns MP. Fatty liver disease It’s more than alcohol and obesity. Medscape Gastroenterology 2003; 5(2).
Amarapurkar DN, Amarapurkar AD. Non alcoholic steatohepatitis: Clinicological profile. J Assoc Physicians India 2000; 48: 311-313.
Choudhury J, Sanyal AJ. Clinical aspects of fatty liver disease. Semin Liver Dis 2004; 24: 349-362.
Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: The dionysos nutrition and liver study. Hepatology 2005; 42:44-52.
Kim HJ, Kim HJ, Lee KE, Kim DJ, Kim SK, Ahn CW, Lim SK, Kim KR, Lee HC, Huh SB, Cha BS. Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults. Arch Intern Med 2004; 164: 2169-75.
Bellentani S, Saccoccio G, Masutti F, Croce LS, Brandi G, Sasso F, Cristanini G, Tiribelli C. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med 2000; 132: 112-117.
James O, Day P. Nonalcoholic steatohepatitis (NASH): a disease of emerging identity and importance. J Hepatol 1998; 29: 495-501.
Czaja A, Carpenter H, Santroch P, et al. Host and disease specific factors affecting steatosis in chronic hepatitis C. J Hepatol 1998; 29: 198-206.
Singh SP, Nayak S, Swain M, Rout N, Mallik RN, Agrawal O, Meher C, Rao M. Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Trop Gastroenterol 2004; 25: 76-9.
Leevy CM. A study of 270 patients with biopsy proven fatty liver and a review of the literature. Medicine (Baltimore) 1962; 41: 249-76.
Sherlock S, Dooley J. Nutritional and metabolic liver diseases. In: Sherlock S, Pooley J eds. Diseases of the liver and biliary system. Blackwell Science Ltd, 1997: 427-453.
Gupta S, Meena HS, Chopra R. Hepatic involvement in tuberculosis. Journal of Association of Physicians of India 1993; 41: 20-22.
Thulstrup Am, Molle I, Svendsen N, Sorenson HT. Incidence and prognosis of tuberculosis in patients with cirrhosis of the liver. A Danish nationwide population based study. Epidemiol Infect 2000; 124: 221-225.
Rathi PM, Amarapurkar DN, Borges NE, Koppikar GV, Kalro RH. Spectrum of liver diseases in HIV infection. Indian J Gastroenterology 1997; 16: 94-5.
Poonawala A, Nair Sp, Thuluvath PJ. Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis. Hepatology 2000; 32: 689-692.
Caldwell SH, Oelsner DH, Lessoni JC, Hespenheide EE, Battle EH, Driscoll CJ. Cryptogenic cirrhosis: Clinical and risk factors for underlying disease. Hepatology 1999; 29: 664-669.
Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 1990; 12: 1106-1110.
Donati G, Stagni B, Piscaglia F, Venturoli N, Morselli-Labate AM, Rasciti L, Bolondi L. Increased prevalence of fatty liver in arterial hypertensive patients with normal liver enzymes: role of insulin resistance. Gut 2004; 53: 1020-1023.
Ferrannini E, Buzzigoli G, Bonadonna R, et al. Insulin resistance in essential hypertension. N Engl J Med 1987; 317: 350-357.
Rozario R, Ramakrishna B. Histopathological study of chronic hepatitis B and C: a comparison of two scoring system. J Hepatol 2003; 38: 223-9.
Amarapurkar AD, Sangle NA. Histological spectrum of liver in HIV - autopsy study. Ann Hepatol 2005; 4: 47-51.