Elsevier

Journal of Hepatology

Volume 35, Issue 5, November 2001, Pages 568-574
Journal of Hepatology

Non-alcoholic fatty liver disease in an area of southern Italy: main clinical, histological, and pathophysiological aspects

https://doi.org/10.1016/S0168-8278(01)00192-1Get rights and content

Abstract

Background/Aims: Studies on non-alcoholic fatty liver disease (NAFLD) have included chronic liver damage attributed to various causes. Our investigation was held to observe the main clinical, histological, and pathophysiological aspects of NAFLD in patients not exposed to any known cause of chronic liver disease.

Methods: We evaluated, in 84 in-patients (male/female, 66/18; median age, 36 years), the clinical and biochemical characteristics of NAFLD, and particularly its association with diabetes, dyslipidemia, hyperinsulinemia and/or with the increase of parameters of oxidative stress (blood levels of malonyldialdehyde, 4-hydroxynonenal and total plasma antioxidant capacity).

Results: Ninety percent of patients had an increased body mass index (BMI), 35% had dyslipidemia, 40% had sub-clinical diabetes (only 3% had overt diabetes), 60% had hyperinsulinemia, and more than 90% had enhanced levels of lipid peroxidation markers. In 48 patients who had consented to liver biopsy, we found: 14 with simple steatosis, 32 with steatohepatitis, and two with cirrhosis.

Conclusions: Our data indicate that in our country, NAFLD may occur in young males with an increased BMI, with or without hyperinsulinemia, dyslipidemia and diabetes, generally associated with disorders of redox status, and that it may be differentiated from steatosis to steatohepatitis or cirrhosis only with a liver biopsy.

Introduction

Many papers published on non-alcoholic steatohepatitis (NASH) have included subjects with chronic liver damage from a variety of causes [1], [2], [3], [4], [5], [6]. In clinical practice, the interest in this syndrome is owing to the presence of NASH in subjects with routine drug use or exposure to toxins, or with obesity or rapid weight loss, all conditions of emerging social importance [7], [8], [9], [10], [11], [12], [13]. Researchers are also attracted to this syndrome because its pathogenic mechanisms suggest how liver steatosis, through necrosis and inflammation, may lead to fibrosis and cirrhosis [14], [15]. The appearance of NASH is related, in animals and humans, to enhanced lipid peroxidation, mitochondrial dysfunction, altered iron, lipid and carbohydrate metabolism [5], [6], [14], [15], [16], [17]. However, despite the large number of papers published, few studies have aimed at simultaneously defining the different clinical, histological, pathogenic, and therapeutic aspects of non-alcoholic fatty liver disease (NAFLD).

Our country is characterized by a high prevalence of hepatitis B or C virus (HBV, HCV) infection [18] and high alcohol consumption/capita per year [19]. Nonetheless, about 3–5% of liver patients/year, observed at the Liver Units of our Departments from 1996 to 1999, tested negative for the leading known causes of chronic liver disease [20].

We held this study to characterize these patients by evaluating the clinical aspects, type of liver damage, and the relationships occurring among liver histology, body weight, insulinemia, parameters of oxidative stress, and iron, lipid and carbohydrate metabolism.

Section snippets

Patients and methods

The study protocol, according to Helsinki criteria, was approved by the Ethic Committee of our Department. All patients had given informed consent for participation.

Eighty-four subjects were selected from 2100 patients who were being observed at our units for liver problems according to the following criteria: (1), abnormally high plasma aminotransferase (AST and ALT) and/or gamma-glutamyl-transpeptidase (γGT) levels for at least 12 months; (2), presence/absence of ultrasonographic bright

Clinical aspects

The main clinical data of participants are summarized in Table 1. Subjects were predominantly male. When compared, their median age resulted in being lower than that of the female subjects. In 58/66 men (87.8%) and in 17/18 women (94.4%), the BMI was above normal values reported for our country [25] (median value in both sexes, 26.7; range, 19.53–32.31). Clear obesity was found only in four patients, while none claimed to have recent weight loss or variations in their dietary regimen and/or

Discussion

There are four major results of our study: (1), NAFLD, ranging from steatosis to NASH or cirrhosis, was present in approximately 5% of patients observed at our liver units; (2), we have described its primary clinical characteristics; (3), we have demonstrated the relationships occurring among liver histology, BMI, insulinemia, iron, lipid and carbohydrate metabolism, and parameters of oxidative stress; and (4), we have given a preliminary suggestion for possible dietetic and/or therapeutic

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