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      Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis

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          Abstract

          New England Journal of Medicine, 362(18), 1675-1685

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          Nonalcoholic steatohepatitis: an expanded clinical entity.

          M J Farahvash, Brent Neuschwander-Tetri, C G Janney … (1994)
          In the past, nonalcoholic steatohepatitis has been described mostly in obese women with diabetes. The aim of this study was to describe a series of patients with nonalcoholic steatohepatitis with a different clinical profile. The clinical, biochemical, and histological features of 33 patients with nonalcoholic steatohepatitis seen from July 1990 to June 1993 were analyzed. The mean age was 47 years. All patients were antibody to hepatitis C virus-negative. Nineteen of 33 (58%) were men, 20 of 33 (61%) were nonobese, 26 of 33 (79%) had normal glucose levels, and 26 of 33 (79%) had normal lipid levels. Fourteen of 33 (42%) had normal glucose and lipid levels and were not obese. Thirteen of 33 (39%) had pathological increases in fibrosis, 5 of whom had micronodular cirrhosis. Of these 13 with severe, progressive disease, 8 (62%) were women, 8 (62%) were obese, 4 (31%) were diabetic or had an elevated glucose level, and 3 (23%) had hyperlipidemia. Although serum iron studies (transferrin saturation and ferritin) were abnormal in 18 of 31 (58%), no patient had hemochromatosis. Nonalcoholic steatohepatitis can be a severe, progressive liver disease leading to the development of cirrhosis. It should no longer be considered a disease predominantly seen in obese women with diabetes.
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            The natural history of nonalcoholic steatohepatitis: A follow-up study of forty-two patients for up to 21 years

            June W. Halliday, Reginald Hanson, Jeffrey Searle … (1990)
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              Relationship of steatosis grade and zonal location to histological features of steatohepatitis in adult patients with non-alcoholic fatty liver disease.

              , Naga Chalasani, Elizabeth Brunt … (2008)
              The relationship between severity and zonal location of steatosis and the presence of steatohepatitis and various histological features that define NASH has not been formally studied. We conducted a study to examine the relationship of severity and zonal location of steatosis to the presence of NASH and to other histological features that define NASH in adult patients with NAFLD. Steatosis was graded as mild, moderate or severe. We examined the relationship between severity and zonal location of steatosis and the following: lobular inflammation, presence of ballooning, Mallory bodies, fibrosis score, and definite steatohepatitis. Mild, moderate and severe steatosis was present in 44%, 31% and 25% of biopsies, respectively. Definite steatohepatitis was present in 59% and advanced fibrosis in 29% of liver biopsies. Increasing levels of steatosis severity were positively associated with lobular inflammation (p<0.0001), zone 3 fibrosis (p<0.001), and definite steatohepatitis (p=0.02), but were unrelated to ballooning, Mallory bodies, or advanced fibrosis. As compared to zone 3 steatosis, pan-acinar steatosis was more often associated with ballooning, Mallory bodies, and advanced fibrosis. Patients with severe steatosis are more likely to have steatohepatitis. More studies are needed to confirm this observation and to explore its significance.
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                Author and article information

                Journal
                Publisher: Massachusetts Medical Society
                Publication date (Electronic): 2010
                Publication date (Issued): 06 May 2010
                Publication date Updated: 28 May 2019
                Article
                DOI: 10.1056/NEJMOA0907929
                PMC ID: 2928471
                PubMed ID: 20427778
                SO-VID: 8bd522c9-3b84-497a-8803-bbf4b588b239
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