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Nonalcoholic fatty liver disease in severely obese subjects.
Am J Gastroenterol. 2007 Feb; 102(2):399-408.AJ

Abstract

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) has been consistently associated with obesity and insulin resistance. Nonalcoholic steatohepatitis (NASH) is a histological entity within NAFLD that can progress to cirrhosis. The exact prevalence of NASH in severe obesity is unknown. It is unclear whether differences in insulin sensitivity exist among subjects with NASH and simple fatty liver.

OBJECTIVE

To evaluate the prevalence and correlates of NASH and liver fibrosis in a racially diverse cohort of severely obese subjects.

DESIGN

Ninety-seven subjects were enrolled. Liver biopsies, indirect markers of insulin resistance, metabolic parameters, and liver function tests were obtained.

RESULTS

Thirty-six percent of subjects had NASH and 25% had fibrosis. No cirrhosis was diagnosed on histology. Markers of hyperglycemia, insulin resistance, and the metabolic syndrome but not body mass index were associated with the presence of NASH and fibrosis. Elevated transaminase levels correlated strongly with NASH and fibrosis but 46% subjects with NASH had normal transaminases. Subjects with NASH had more severe insulin resistance when compared to those with simple fatty liver. A signal detection model incorporating AST and the presence of diabetes predicted the presence of NASH while another incorporating ALT and HbA1C predicted the presence of fibrosis.

CONCLUSIONS

NAFLD is associated with the metabolic syndrome rather than excess adipose tissue in severe obesity. Insulin resistance is higher in subjects with NASH versus those with simple fatty liver. Statistical models incorporating markers of liver injury and hyperglycemia may be useful in predicting the presence of liver pathology in this population.

Authors+Show Affiliations

Division of Gastroenterology, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17311652

Citation

Gholam, Pierre M., et al. "Nonalcoholic Fatty Liver Disease in Severely Obese Subjects." The American Journal of Gastroenterology, vol. 102, no. 2, 2007, pp. 399-408.
Gholam PM, Flancbaum L, Machan JT, et al. Nonalcoholic fatty liver disease in severely obese subjects. Am J Gastroenterol. 2007;102(2):399-408.
Gholam, P. M., Flancbaum, L., Machan, J. T., Charney, D. A., & Kotler, D. P. (2007). Nonalcoholic fatty liver disease in severely obese subjects. The American Journal of Gastroenterology, 102(2), 399-408.
Gholam PM, et al. Nonalcoholic Fatty Liver Disease in Severely Obese Subjects. Am J Gastroenterol. 2007;102(2):399-408. PubMed PMID: 17311652.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonalcoholic fatty liver disease in severely obese subjects. AU - Gholam,Pierre M, AU - Flancbaum,Louis, AU - Machan,Jason T, AU - Charney,Douglas A, AU - Kotler,Donald P, PY - 2007/2/22/pubmed PY - 2007/3/14/medline PY - 2007/2/22/entrez SP - 399 EP - 408 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 102 IS - 2 N2 - BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been consistently associated with obesity and insulin resistance. Nonalcoholic steatohepatitis (NASH) is a histological entity within NAFLD that can progress to cirrhosis. The exact prevalence of NASH in severe obesity is unknown. It is unclear whether differences in insulin sensitivity exist among subjects with NASH and simple fatty liver. OBJECTIVE: To evaluate the prevalence and correlates of NASH and liver fibrosis in a racially diverse cohort of severely obese subjects. DESIGN: Ninety-seven subjects were enrolled. Liver biopsies, indirect markers of insulin resistance, metabolic parameters, and liver function tests were obtained. RESULTS: Thirty-six percent of subjects had NASH and 25% had fibrosis. No cirrhosis was diagnosed on histology. Markers of hyperglycemia, insulin resistance, and the metabolic syndrome but not body mass index were associated with the presence of NASH and fibrosis. Elevated transaminase levels correlated strongly with NASH and fibrosis but 46% subjects with NASH had normal transaminases. Subjects with NASH had more severe insulin resistance when compared to those with simple fatty liver. A signal detection model incorporating AST and the presence of diabetes predicted the presence of NASH while another incorporating ALT and HbA1C predicted the presence of fibrosis. CONCLUSIONS: NAFLD is associated with the metabolic syndrome rather than excess adipose tissue in severe obesity. Insulin resistance is higher in subjects with NASH versus those with simple fatty liver. Statistical models incorporating markers of liver injury and hyperglycemia may be useful in predicting the presence of liver pathology in this population. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/17311652/Nonalcoholic_fatty_liver_disease_in_severely_obese_subjects_ L2 - http://Insights.ovid.com/pubmed?pmid=17311652 DB - PRIME DP - Unbound Medicine ER -