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Órgano Oficial de la Asociación Mexicana de Hepatología

2007, Number 4

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Ann Hepatol 2007; 6 (4)

Changes in histological criteria lead to different prevalences of nonalcoholic steatohepatitis in severe obesity

Pedrosa de OC, Sobroza de ME, Alves VAF, Mahmud SS, Strauss E

Language: English
References: 50
Page: 255-261
PDF size: 187.66 Kb.


Text Extraction

The worldwide obesity epidemic contributes to the increasing incidence of a number of diseases, as nonalcoholic fatty-liver disease (NAFLD) and its most severe form, the nonalcoholic steatohepatitis (NASH). Data on the prevalence of NASH has varied from 18.5% to 69% in obesity, an unacceptable wide range. The aim of our study was to evaluate how prevalence of NASH is influenced by the different diagnostic histological criteria. Consecutive assessment of 325 obese patients referred for bariatric surgery (BMI ≥ 35 kg/m2), 146 of whose were submitted to histological analysis of the liver allowed the evaluation of the prevalence of NAFLD. Steatohepatitis was diagnosed histologically using 3 types of criteria: a) broad criteria, where steatosis was associated with at least 2 of the following parameters: any degree of lobular inflammatory infiltrate, hepatocellular ballooning and perisinusoidal/perivenular fibrosis; b) restricted criteria, where the hepatocellular ballooning was of moderate or severe intensity; c) ultrarestricted criteria, which required perisinusoidal and/or perivenular fibrosis. NAFLD was present in 111 (76%) of the patients, and the prevalence of NASH was 25.3% when ultrarestricted criteria were used, 41.1% with restricted criteria and 55.5% with broad criteria. In conclusion, more accurate definition of the criteria for histological diagnosis of NASH should be required, so that further clinico-pathological studies may define the long-term progression of the disease and evaluate therapeutic strategies.


REFERENCES

  1. World Health Organization. Obesity: an epidemic. Report of the World Health Organization. Geneva, 2000.

  2. Suriawinata A, Fiel MI. Liver pathology in obesity. Semin Liver Dis 2004; 24(4): 363-70.

  3. Nugent C, Younossi ZM Evaluation and management of obesity-related nonalcoholic fatty liver disease. Nat Clin Pract Gastroenterol Hepatol 2007; 4: 432-41.

  4. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346: 1221-31.

  5. Wanless I, Lentz J. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 1990; 12: 1106-10.

  6. Nasrallah SM, Wills CE, Galambos JT. Hepatic morphology in obesity. Digestive Disease and Sciences 1981; 26(4): 325-27.

  7. Schaffner F, Thaler H. Nonalcoholic fatty liver disease. Prog Liver Dis 1986; 8: 283-98.

  8. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413-9.

  9. Powell E, Cooksley W, Hanson R, Searle J, Halliday J, Powell L. The natural history of nonalcoholic steatohepatitis: a follow up study of 42 patients for up to 21 years. Hepatology 1990; 11: 74-80.

  10. Adler M, Schaffner F. Fatty liver hepatitis and cirrhosis in obese patients. Am J Med 1979; 67: 811-6.

  11. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 2003; 348: 1625-38.

  12. Soresen HT, Mellemkjaer L, Jepsen P, Thulstrup AM, Baron J, Ols JH, et al. Risk of cancer in patients hospitalized with fatty liver: a Danish cohort study. J Clin Gastroenterol 2003; 36: 356-9.

  13. Luyckx FH, Desaive C, Thiry A, et al. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord 1998; 22(3): 222-6.

  14. Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic and liver fibrosis in the severaly obese. Gastroenterology 2001; 121: 91-100.

  15. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980; 55: 434-8.

  16. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999; 94: 2467-74.

  17. Sanyal AJ. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology 2002; 23: 1705-25.

  18. Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology 2003; 37: 1202-19.

  19. Joy D, Thava VR, Scott BB. Diagnosis of fatty liver disease: is biopsy necessary? European Journal of Gastroenterology & Hepatology 2003; 15: 539-43.

  20. Hübscher SG. Role of liver biopsy in the assessment of non-alcoholic fatty liver disease. European Journal of Gastroenterology & Hepatology 2004; 16: 1107-15.

  21. Brunt EM. Nonalcoholic steatohepatitis. Semin Liver Dis 2004; 24(1): 3-20.

  22. Bellentani S, Bedogni G, Miglioli L, Tiribelli C. The epidemiology of fatty liver. Eur J Gastroenterol Hepato 2004; 16(11): 1087-93.

  23. Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001; 121: 710-23.

  24. Clark JM, Brancati FL, Diehl AM. Nonalcoholic fatty liver disease. Gastroenterology 2002; 122: 1649-57.

  25. Farrell GC. Drugs and steatohepatitis. Semin Liver Dis 2002; 22(2): 185-94.

  26. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2002; 25 (90001): S5-20.

  27. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-2497.

  28. Freitas, LAR. CC-2 Curso curto em patologia hepática. Cirrose hepática: vias etiopatogênicas e seus marcadores histológicos. esteato-hepatites alcoólica e não-alcoólica. Congresso Brasileiro de Patologia. Natal, 2005.

  29. Gayotto LCC. Esteato-hepatite não-alcoólica. In Gayotto LCC, Alves AAF. Doenças do fígado e vias biliares. São Paulo: Atheneu; 2001b: 413-20.

  30. Bloomgarden ZT. American Association of Clinical Endocrinologists (AACE) consensus conference on the insulin resistance syndrome: 25-26 August 2002, Washington, DC. Diabetes Care 2003; 26(4): 1297-303.

  31. Marchesini G, Bugianesi E, Forlani G, Cerelli F, Lenzi M, Manini R, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003; 37: 917-23.

  32. Bellentani S, Saccoccio G, Masutti F, Croce LS, Brandi G, Sasso F, Cristianini G, Tribelli C. Prevalence of and risk factors for hepatic steatosis in northern Italy. Ann Intern Med 2000; 132: 112-7.

  33. Silverman JF, O’Brien KF, Long S, Leggett N, Khazanie PG, Pories WJ, Norris HT, Caro JF. Liver pathology in morbidly obese patients with and without diabetes. Am J Gastroenterol 1990; 85(10): 1349-55.

  34. Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 2001; 21: 17-26.

  35. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. Adults. Diabetes Care 2004; 27(10): 2444-9.

  36. Chitturi S, Abeygunasekera S, Farrell GC, Holmes-Walker J, Hui JM, Fung C, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 2002; 35: 373-9.

  37. Sanyal AJ, Campbell-Sargent C, Mirshahi F, Rizzo WB, Contos MJ, Sterling RK, Luketic VA, Shiffmann ML, Clore JN. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology 2001; 120: 1183-92.

  38. Chitturi S, Farrell GC. Etiopathogenesis of nonalcoholic steatohepatitis. Semin Liver Dis 2001; 21(1): 27-41.

  39. Marceau P, Biron S, Hould F-S, Marceau S, Simard S, Thung SN, et al. Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metab 1999; 84(5): 1513-7.

  40. Araujo LM, De Oliveira DA, Nunes DS. Liver and biliary ultrasonography in diabetic and non-diabetic obese women. Diabetes Metab 1998; 24(5): 458-62.

  41. Daniel S, Ben-Menachem T, Vasudevan G, Ma CK, Blumenkehl M. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 1999; 94(10): 3010-4.

  42. Brunt EM. Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 2001; 21: 3-16.

  43. Garcia-Monzon C, Martin-Perez E, Iacono OL, Fernandez-Bermejo M, Majano PL, Apolinario A, Larranaga E, Moreno-Otero R. Characterization of pathogenic and prognostic factors of nonalcoholic steatohepatitis associated with obesity. J Hepatol 2000; 33: 716-24.

  44. Beymer C, Kowdley KV, Larson A, Edmonson P, Dellinger EP, Flum DR. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg 2003; 138: 1240-1244.

  45. Abrams GA, Kunde SS, Lazenby AJ, Clements RH. Portal fibrosis and hepatic steatosis in morbidly obese subjects: A spectrum of nonalcoholic fatty liver disease. Hepatology 2004; 40: 475-483.

  46. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41(6): 1313-21.

  47. Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I, Khalil L, Turpin G, Opolon P, Poynard T. Liver fibrosis in overweight patients. Gastroenterology 2000; 118: 1117–23.

  48. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999; 30: 1356-1362

  49. Brunt EM, Ramrakhiani S, Cordes BG, Neuschwander-Tetri BA, Janney CG, Bacon BR, et al. Concurrence of histologic features of steathepatitis with other forms of chronic liver disease. Mod Pathol 2003; 16: 49-56.

  50. Caldwell SH, Oelsner DH, Iezzoni JC, Hespenheide EE, Battle EH, Driscoll CJ. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 1999; 29: 664-9.




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