Clinics and Research in Hepatology and Gastroenterology
Original articleProgression from isolated steatosis to steatohepatitis and fibrosis in nonalcoholic fatty liver disease
Section snippets
Patients and methods
We reviewed the records of six patients (four men) who had been initially diagnosed with bland steatosis related to primary NAFLD seen in a tertiary referral center between 1998 and 2009 and who had undergone a follow-up liver biopsy more than one year after the index biopsy. At the baseline evaluation, other causes of liver disease were ruled out in these patients:
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daily alcohol consumption greater than 30 g for men and 20 g for women;
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drug-induced hepatotoxicity;
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infection with HBV or HCV viruses;
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Patient characteristics at baseline and follow-up
The clinical and biological characteristics of the individual patients are presented in Table 1. The median body mass index (BMI) was 27 kg/m2 (range from 22.5 to 31.6) at baseline; only one patient had grade I obesity, four other patients had overweight, and one patient had a normal weight. The median ALT was 61 IU/l (range from 30 to 114 IU/l); the median serum glucose, fasting insulin and HOMA levels were 5.28 mmol/l (range from 5.1 to 5.6 mmol/l), 10.85 μIU/ml (range from 5 to 30 μIU/l) and 2.57
Histological progression
The median interval between the two biopsies was five years (range two to ten years). The median sample size was 18.5 mm (range 13 to 25 mm) and 26 mm (range 10 to 33 mm) for the initial and follow-up biopsies, respectively, with a median number of portal tracts of 12.5 (range 6–16) and 17.5 (range 2–24), respectively. At baseline, all patients had isolated steatosis without associated inflammation or liver cell injury. Four patients had significant steatosis involving more than 66% of the liver
Discussion
This retrospective case series clearly documents that patients with isolated steatosis can progress to NASH. All patients had a second liver biopsy compatible with steatohepatitis, as ballooning was present in all patients and most displayed lobular inflammation in addition to ballooning. Another element indicative of real disease progression in these patients is the occurrence of fibrosis along with steatohepatitis in some of the patients described here. Remarkably, the occurrence of
Conflict of interest
There is no conflict of interest.
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