Non-Alcoholic Steatohepatitis (NASH): Risk Factors in Morbidly Obese Patients.

Alexandre Losekann,Antonio Weston,Cristiane Tovo,Gabriela Coral,Marilia Espindola,Sergio Pioner,Luis De Carli,Angelo De Mattos

doi:10.3390/ijms161025552

Abstract

The aim was to investigate the prevalence of non-alcoholic steatohepatitis (NASH) and risk factors for hepatic fibrosis in morbidly obese patients submitted to bariatric surgery. This retrospective study recruited all patients submitted to bariatric surgery from January 2007 to December 2012 at a reference attendance center of Southern Brazil. Clinical and biochemical data were studied as a function of the histological findings of liver biopsies done during the surgery. Steatosis was present in 226 (90.4%) and NASH in 176 (70.4%) cases. The diagnosis of cirrhosis was established in four cases (1.6%) and fibrosis in 108 (43.2%). Risk factors associated with NASH at multivariate analysis were alanine aminotransferase (ALT) >1.5 times the upper limit of normal (ULN); glucose ≥ 126 mg/dL and triglycerides ≥ 150 mg/dL. All patients with ALT ≥1.5 times the ULN had NASH. When the presence of fibrosis was analyzed, ALT > 1.5 times the ULN and triglycerides ≥ 150 mg/dL were risk factors, furthermore, there was an increase of 1% in the prevalence of fibrosis for each year of age increase. Not only steatosis, but NASH is a frequent finding in MO patients. In the present study, ALT ≥ 1.5 times the ULN identifies all patients with NASH, this finding needs to be further validated in other studies. Moreover, the presence of fibrosis was associated with ALT, triglycerides and age, identifying a subset of patients with more severe disease.

Highlights

Nonalcoholic fatty liver disease (NAFLD) embraces a wide range of manifestations that includes simple steatosis (SS), non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma [1,2].The real prevalence of NASH is not known, as the disease is usually asymptomatic and that the definitive diagnosis is possible only by the histopathological assessment [3,4]
When liver biopsies performed before and after the weight loss caused by the surgery were compared, it was shown that this treatment determines an improvement or stabilization of SS, NASH and fibrosis [9,10]
NAFLD was present in 90.4% of the Morbidly obese (MO) patients submitted to bariatric surgery (BS)

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) embraces a wide range of manifestations that includes simple steatosis (SS), non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma [1,2]. The real prevalence of NASH is not known, as the disease is usually asymptomatic and that the definitive diagnosis is possible only by the histopathological assessment [3,4]. Obese (MO) patients, defined as body mass index (BMI) ≥35 and experiencing obesity-related health conditions or ≥40 kg/m2, are a subgroup with higher risk of NAFLD. In these patients, the prevalence of NAFLD is estimated from 84% to 96% and of NASH from 25% to 55%. In those with NASH, there is bridging fibrosis or cirrhosis at a rate of 12% and 2% respectively [4,6]

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