Abstract
Recent studies report a prevalence of non-alcoholic fatty liver disease (NAFLD) of between 70% and 80% in patients with metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM). Nevertheless, it is not possible to differentiate between simple steatosis and non-alcoholic steatohepatitis (NASH) with non-invasive tests. The aim of this study was to differentiate between simple steatosis and NASH by liver biopsy in patients with hypertransaminasemia and MS or T2DM. Two hundred and fifteen patients with increased ALT levels and MS, and 136 patients at their first diagnosis of T2DM regardless of ALT values were consecutively admitted to a tertiary hepatology center between January 2004 and November 2014. Exclusion criteria were other causes of liver disease/ALT increase. Each patient underwent a clinical, laboratory and ultrasound evaluation, and a liver biopsy. Gender distribution, age, and body mass index were similar in the two groups of patients, whereas cholesterol levels, glycemia and blood pressure were significantly different between the two groups. The prevalence of NAFLD was 94.82% in MS patients and 100% in T2DM patients. NASH was present in 58.52% of MS patients and 96.82% of T2DM. Consequently, this study reveals that, by using liver biopsy, almost all patients with T2DM or MS have NAFLD, which in patients with T2DM means NASH. Importantly, it suggests that NASH may be one of the early complications of T2DM due to its pathophysiological correlation with insulin resistance.
Highlights
Liver diseases encompass a wide range of clinical signs and histological damage that lead to different degrees of necrosis, inflammation and fibrosis, of which the pathological accumulation of fat in the liver cell is often considered one of the first steps of an evolving chronic process [1,2]
The prevalence of nonalcoholic steatohepatitis (NASH) and cirrhosis was higher in patients with type 2 diabetes mellitus (T2DM) than in patients with metabolic syndrome (MS) (p
Non-alcoholic fatty liver disease is considered a benign disease, mostly related to the different clinical expression of insulin resistance (IR), which ranges from altered lipid metabolism to MS and/or T2DM [8]
Summary
Liver diseases encompass a wide range of clinical signs and histological damage that lead to different degrees of necrosis, inflammation and fibrosis, of which the pathological accumulation of fat in the liver cell (namely steatosis) is often considered one of the first steps of an evolving chronic process [1,2]. Liver steatosis is frequently reported in patients affect by obesity or type 2 diabetes mellitus (T2DM) [3]. The main pathophysiological mechanisms underlying liver steatosis are, at intracellular level, mitochondrial alterations that are involved in insulin resistance (IR) [4]. These alterations represent the pathophysiological link to the clinical. Liver biopsy in T2DM: Features of NASH
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