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Portal chronic inflammation in nonalcoholic fatty liver disease (NAFLD): a histologic marker of advanced NAFLD-Clinicopathologic correlations from the nonalcoholic steatohepatitis clinical research network.
Hepatology. 2009 Mar; 49(3):809-20.Hep

Abstract

Adult nonalcoholic fatty liver disease (NAFLD) is characterized by absent or mild portal chronic inflammation (CI); in children, portal CI may be predominant. This study correlated clinical features with portal CI. Centrally-graded biopsies and temporally-related clinical parameters from 728 adults and 205 children. From the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) were evaluated. Mild, more than mild and no portal CI were found in 60%, 23% and 16% of adult biopsies and 76%, 14% and 10% of pediatric biopsies. Autoantibodies, and elevated alanine aminotransferase were not associated with portal CI. Clinical features associated with "more than mild" in adults were older age (P < 0.0001), female gender (P = 0.001), higher body mass index (P < 0.0001), elevated insulin levels (P = 0.001), higher homeostasis model assessment of insulin resistance score (HOMA-IR) (P < 0.0001), and medications used for NAFLD (P = 0.0004), diabetes (P < 0.0001), and hypertension (P < 0.0001). "More than mild" in the pediatric biopsies correlated with younger age (P = 0.01), but not with body mass index, insulin or HOMA-IR. In both groups, lobular and portal inflammation scores had no association, but there was an association with definite steatohepatitis (P < 0.0001). Features associated in the adult biopsies with "more than mild" were steatosis amount (P = 0.01) and location (P < 0.0001), ballooning (P < 0.0001), and advanced fibrosis (P < 0.0001). In the pediatric biopsies, "more than mild" was associated with steatosis location (P = 0.0008) and fibrosis score (P < 0.0001), specifically, the portal/periportal fibrosis or greater fibrosis) (P < 0.01).

CONCLUSION

Increased portal CI is associated with many clinical and pathologic features of progressive NAFLD in both adults and children, but not with ALT, autoantibodies, or lobular inflammation. More than mild portal CI in liver biopsies of untreated NAFLD may be considered a marker of advanced disease.

Authors+Show Affiliations

Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO 63110, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19142989

Citation

Brunt, Elizabeth M., et al. "Portal Chronic Inflammation in Nonalcoholic Fatty Liver Disease (NAFLD): a Histologic Marker of Advanced NAFLD-Clinicopathologic Correlations From the Nonalcoholic Steatohepatitis Clinical Research Network." Hepatology (Baltimore, Md.), vol. 49, no. 3, 2009, pp. 809-20.
Brunt EM, Kleiner DE, Wilson LA, et al. Portal chronic inflammation in nonalcoholic fatty liver disease (NAFLD): a histologic marker of advanced NAFLD-Clinicopathologic correlations from the nonalcoholic steatohepatitis clinical research network. Hepatology. 2009;49(3):809-20.
Brunt, E. M., Kleiner, D. E., Wilson, L. A., Unalp, A., Behling, C. E., Lavine, J. E., & Neuschwander-Tetri, B. A. (2009). Portal chronic inflammation in nonalcoholic fatty liver disease (NAFLD): a histologic marker of advanced NAFLD-Clinicopathologic correlations from the nonalcoholic steatohepatitis clinical research network. Hepatology (Baltimore, Md.), 49(3), 809-20. https://doi.org/10.1002/hep.22724
Brunt EM, et al. Portal Chronic Inflammation in Nonalcoholic Fatty Liver Disease (NAFLD): a Histologic Marker of Advanced NAFLD-Clinicopathologic Correlations From the Nonalcoholic Steatohepatitis Clinical Research Network. Hepatology. 2009;49(3):809-20. PubMed PMID: 19142989.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Portal chronic inflammation in nonalcoholic fatty liver disease (NAFLD): a histologic marker of advanced NAFLD-Clinicopathologic correlations from the nonalcoholic steatohepatitis clinical research network. AU - Brunt,Elizabeth M, AU - Kleiner,David E, AU - Wilson,Laura A, AU - Unalp,Aynur, AU - Behling,Cynthia E, AU - Lavine,Joel E, AU - Neuschwander-Tetri,Brent A, AU - ,, PY - 2009/1/15/entrez PY - 2009/1/15/pubmed PY - 2009/4/2/medline SP - 809 EP - 20 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 49 IS - 3 N2 - UNLABELLED: Adult nonalcoholic fatty liver disease (NAFLD) is characterized by absent or mild portal chronic inflammation (CI); in children, portal CI may be predominant. This study correlated clinical features with portal CI. Centrally-graded biopsies and temporally-related clinical parameters from 728 adults and 205 children. From the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) were evaluated. Mild, more than mild and no portal CI were found in 60%, 23% and 16% of adult biopsies and 76%, 14% and 10% of pediatric biopsies. Autoantibodies, and elevated alanine aminotransferase were not associated with portal CI. Clinical features associated with "more than mild" in adults were older age (P < 0.0001), female gender (P = 0.001), higher body mass index (P < 0.0001), elevated insulin levels (P = 0.001), higher homeostasis model assessment of insulin resistance score (HOMA-IR) (P < 0.0001), and medications used for NAFLD (P = 0.0004), diabetes (P < 0.0001), and hypertension (P < 0.0001). "More than mild" in the pediatric biopsies correlated with younger age (P = 0.01), but not with body mass index, insulin or HOMA-IR. In both groups, lobular and portal inflammation scores had no association, but there was an association with definite steatohepatitis (P < 0.0001). Features associated in the adult biopsies with "more than mild" were steatosis amount (P = 0.01) and location (P < 0.0001), ballooning (P < 0.0001), and advanced fibrosis (P < 0.0001). In the pediatric biopsies, "more than mild" was associated with steatosis location (P = 0.0008) and fibrosis score (P < 0.0001), specifically, the portal/periportal fibrosis or greater fibrosis) (P < 0.01). CONCLUSION: Increased portal CI is associated with many clinical and pathologic features of progressive NAFLD in both adults and children, but not with ALT, autoantibodies, or lobular inflammation. More than mild portal CI in liver biopsies of untreated NAFLD may be considered a marker of advanced disease. SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/19142989/Portal_chronic_inflammation_in_nonalcoholic_fatty_liver_disease__NAFLD_:_a_histologic_marker_of_advanced_NAFLD_Clinicopathologic_correlations_from_the_nonalcoholic_steatohepatitis_clinical_research_network_ L2 - https://doi.org/10.1002/hep.22724 DB - PRIME DP - Unbound Medicine ER -