Liver, Pancreas, and Biliary TractNonalcoholic fatty liver disease: A spectrum of clinical and pathological severity☆,☆☆
Section snippets
Patient population
All liver biopsy specimens obtained 1979 through 1987 with a histological diagnosis of fatty liver (minimum inclusion criteria) were identified through a computerized pathology registry at the Cleveland Clinic. This time period would allow up to 18 years of follow-up for survival analysis and determination of disease progression. Exclusionary criteria included the following: (1) daily alcohol intake >30 g in men or >20 g in women; (2) use of amiodarone, corticosteroids, tamoxifen, methotrexate,
Results
We identified 772 liver biopsy specimens with fatty liver from our computerized pathology registry. After application of exclusion criteria, 157 patients remained, 132 of whom had complete clinical and pathological data. Reasons for liver biopsy were as follows: incidental (i.e., biopsy performed during cholecystectomy or consideration for methotrexate in psoriasis, but methotrexate was never given), 43%; abnormal liver test results, 29%; suspicion of liver disease or cirrhosis, 16%; and
Discussion
This study, with the largest number of patients and longest follow-up of its kind, used established and reliable histological criteria to evaluate outcomes stratified for the different forms of nonalcoholic fatty liver. NAFLD patients were initially separated into four specific histological diagnoses: simple fatty liver (type 1), steatohepatitis (type 2), steatonecrosis (type 3), and steatonecrosis plus either Mallory hyaline or fibrosis (type 4). The demographic and clinical parameters of age,
Acknowledgements
The authors thank Stephen Day, Ph.D., of ViroMED Laboratories, Inc., and Belinda Yen-Lieberman, Ph.D., of the Department of Microbiology, Cleveland Clinic, for their assistance with tissue hepatitis C virus RNA by polymerase chain reaction.
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Address requests for reprints to: Zobair M. Younossi, M.D., M.P.H., Department of Gastroenterology/S40, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195. e-mail: [email protected]; fax: (216) 444-9416.
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Supported in part by a grant from the American College of Gastroenterology.