Abstract
ObjectiveTo identify nonalcoholic steatohepatitis (NASH) and liver stiffness in Mexican subjects with different body mass index (BMI).MethodsA cross-sectional study was conducted in 505 adults. Risk for NASH was defined as the presence of one or more of the following biochemical and metabolic parameters (BMPs): fasting glucose ≥100 mg/dl, triglycerides (TG) ≥150 mg/dl, homeostatic model assessment of insulin resistance (HOMA-IR) ≥2.5, aspartate aminotransferase (AST) >54 IU/L and alanine aminotransferase (ALT) >42 IU/L. Body mass index measurement and nutritional assessment were performed by standard procedures. Liver fibrosis stage was determined by liver stiffness measurement using transitional elastography (TE) or by liver biopsy (LB).ResultsRisk for NASH was 57% (290/505). Most BMPs values incremented by BMI category. Among 171 at-risk patients, 106 subjects were evaluated by TE and 65 subjects by LB. Abnormal liver stiffness (≥6.0 kPa) was prevalent in 54% (57/106) of the cases, whereas by LB, 91% (59/65) of patients with obesity had NASH and liver fibrosis. Furthermore, liver fibrosis was prevalent in 46% (6/13) in normal weight individuals, whereas 4.6% (3/65) of patients with a BMI ≥ 35 kg/m2 showed no histopathological abnormalities. Overall, 67.8% (116/171) of the patients had abnormal liver stiffness or NASH. The normal weight patients with liver damage consumed relatively a higher fat-rich diet compared to the other groups whereas the remaining subgroups shared a similar dietary pattern.ConclusionYoung patients with overweight and obesity showed a high prevalence of altered BMPs related to abnormal liver stiffness assessed by TE and NASH by LB. Early diagnostic strategies are required to detect the risk for NASH and avoid further liver damage in populations with a rising prevalence of obesity by defining the risk factors involved in the onset and progression of NASH.
Highlights
The main etiologies of chronic liver disease worldwide are chronic alcohol abuse, viral hepatitis B and C followed by nonalcoholic fatty liver disease (NAFLD) [1]
Young patients with overweight and obesity showed a high prevalence of altered biochemical and metabolic parameters (BMPs) related to abnormal liver stiffness assessed by transient elastography (TE) and non-alcoholic steatohepatitis (NASH) by liver biopsy (LB)
Biochemical and metabolic parameters of subjects at risk for NASH adjusted by body mass index (BMI)
Summary
The main etiologies of chronic liver disease worldwide are chronic alcohol abuse, viral hepatitis B and C followed by nonalcoholic fatty liver disease (NAFLD) [1]. In high-resource countries, alcoholic liver disease has decreased in the last decade [3], whereas the new era of direct-acting antivirals promises near-future eradication of hepatitis C virus [4,5]. These tendencies may not occur in low-resource countries [6,7]. NAFLD including simple steatosis and non-alcoholic steatohepatitis (NASH) has become a global trend in parallel to the uprising rate of obesity in populations that have acquired a Westernized lifestyle [8]. Genetic susceptibility can importantly modify the incidence and progression of NAFLD/NASH within populations [8,9,10]
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