The researchers investigated the predictors of advanced or progressive non-alcoholic fatty liver disease (NAFLD) in the severely obese.
105 consecutive patients were enrolled in the study. Liver biopsies were taken at laparoscopic obesity surgery in each.
The clinical and biochemical variables were analyzed for correlation with specific histologic features.
26 patients (25%) were found to have non-alcoholic steatohepatitis (NASH). 11 (42%) of these had advanced fibrosis.
|Odds ratios for predictors of NASH:|
Insulin resistance: 9.3
Systemic hypertension: 5.2
The researchers found several independent predictors of NASH. These were a raised index of insulin resistance (odds ratio [OR] 9.3), systemic hypertension (OR 5.2), and raised alanine
aminotransferase (OR 8.6).
A combination of two or three of these predictors allowed a sensitivity of 0.8, and specificity of 0.89, for NASH.
Alcohol consumption was associated with a reduction in NASH (OR 0.35) and diabetes (OR 0.18).
Author John B. Dixon, of the Monash University Department of Surgery, Alfred Hospital, Melbourne, said on behalf of the group, "Insulin resistance and systemic hypertension, features of the metabolic syndrome, are independently associated with advanced forms of non-alcoholic fatty liver disease."
"Moderate alcohol consumption seems to reduce the risk of NAFLD in the severely obese, possibly by reducing insulin resistance," he concluded.