Clinical and histological features of non‐alcoholic fatty liver disease in Hong Kong Chinese

Abstract

Summary Background : Non‐alcoholic fatty liver disease is prevalent in affluent countries and is a cause of cirrhosis and possibly hepatocellular carcinoma. Aim : To examine the clinical and histological features of biopsy‐proven non‐alcoholic fatty liver disease and investigate the predictors of severe histological disease in Chinese patients. Methods : Electronic records of all patients (n = 247) who underwent liver biopsy between 1996 and 2003 in our hospital were retrieved. Patients who had histological features of non‐alcoholic fatty liver disease were identified. The demographic, clinical, laboratory and histological (Brunt's criteria) parameters of these patients were analysed. Results : Forty‐two patients had histology‐proven non‐alcoholic fatty liver disease. The median age was 47 years (range 23–69). All except one patient had features of metabolic syndrome. The median alanine aminotransferase was 93 (range 24–270) IU/L. Thirty‐six (85.7%) patients had steatohepatitis and 11 (26.1%) also had fibrosis. Only one patient had stage 3 fibrosis. The presence of diabetes mellitus predicted higher grade steatohepatitis and fibrosis (P = 0.019) whereas alanine aminotransferase level had no correlation with histological severity of steatohepatitis. After a median follow‐up of 42 months, no patient developed hepatic decompensation. Conclusions : Most Chinese patients with non‐alcoholic fatty liver disease had features of the metabolic syndrome. Histological activity was generally mild. Diabetes mellitus was the most important predictor of severe histological disease.

Metabolic and histological features of non‐alcoholic fatty liver disease patients with different serum alanine aminotransferase levels

“…16,18 One possibility is that those were spurious results because of the use of inappropriate ALT cutoffs.…”

“…This echoes previous cross-sectional studies that obesity and diabetes were the most important factors associated with histological severity. 18,29,33 Metabolic factors are more important than the ALT level in predicting NASH and significant fibrosis. Obesity and the history of impaired fasting glucose or diabetes were independent factors associated with NASH, while age, fasting glucose and insulin resistance (HOMA-IR) were independent factors associated with significant fibrosis.…”

“…The length of liver samples was 18 AE 3 mm (median, 17; interquartile range, [16][17][18][19][20], and the number of portal tracts per sample was 7 AE 2 (median 6; interquartile range, 5-8). The ALT level had moderate correlation with steatosis grade (R = 0.32, P < 0.001), fibrosis stage (R = 0.20, P = 0.008) and the NAFLD activity score (R = 0.28, P < 0.001).…”

“…15 Significant fibrosis has been reported among NAFLD patients with normal ALT. [16][17][18][19] Last but not least, most previous studies only evaluated one ALT level and neglected the potential variability of ALT.…”

Efficacy of Tumor Necrosis Factor and Interleukin-10 Analysis in the Follow-up of Nonalcoholic Fatty Liver Disease Progression

“…This increases the sensitivity of the liver to injury and inflammation [5]. The second step involves cytokines which causing oxidative stress and lipid peroxidation, in time leading to steatohepatitis [6,7] which eventually might develop cirrhosis and hepatocellular carcinoma [8]. Obesity, type 2 (non-insulin dependent) diabetes mellitus, and hyperlipidemia are coexisting conditions frequently associated with NAFLD [9,10].…”