Clinical–Liver, Pancreas, and Biliary TractExpanding the natural history of nonalcoholic steatohepatitis: From cryptogenic cirrhosis to hepatocellular carcinoma☆
Section snippets
Patients
Among 786 white patients with HCC superimposed to liver cirrhosis identified from our Liver Unit registry since 1990, 641 had been submitted to an extensive investigation as part of a diagnostic workup aimed at evaluation for liver transplantation, hepatic resection, or nonsurgical treatment of HCC. In these patients, sufficient data were available to establish the etiology of liver disease.
The clinical history and laboratory data had failed to identify any recognizable cause in 46 patients who
Results
The prevalence of CC in 641 patients with HCC was 6.9%, compared with 54.9% in patients with HCV-related cirrhosis, 16.2% in patients with HBV-related cirrhosis, and 12.9% in patients with postalcoholic cirrhosis. The remaining patients (7.6%) had cirrhosis of mixed etiology (contemporary presence of HBV and/or HCV and/or alcohol). Only a small proportion of patients had hemochromatosis or primary biliary cirrhosis (1.4%). Patients with CC and HCC were older in comparison with the entire
Discussion
This study demonstrates that features suggestive of the metabolic syndrome,9 including type 2 diabetes, obesity, dyslipidemia, and insulin resistance, are observed more frequently in patients with HCC superimposed on cirrhosis of unknown etiology than in carefully matched control patients. Our data are consistent with the existence of a metabolic disorder leading first to fatty liver and then to HCC via NASH, fibrosis, and cirrhosis.
There is a broad consensus that NASH patients share many of
References (42)
- et al.
The natural history of nonalcoholic fatty liver: a follow-up study
Hepatology
(1995) - et al.
Nonalcoholic fatty liver disease: a spectrum of clinical and pathologic severity
Gastroenterology
(1999) - et al.
Pericentral hepatic fibrosis and intracellular hyalin in diabetes mellitus
Gastroenterology
(1980) - et al.
Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a case-control study
Hepatology
(2000) - et al.
Nonalcoholic steatohepatitis and hepatocellular carcinoma: natural history?
Am J Gastroenterol
(2000) - et al.
Noninvasive in vivo quantitative assessment of fat content in human liver
J Hepatol
(1997) Insulin resistance, iron, and the liver
Lancet
(2000)- et al.
Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities
Gastroenterology
(2001) - et al.
Association of nonalcoholic fatty liver disease with insulin resistance
Am J Med
(1999) - et al.
Cryptogenic cirrhosis and posttransplantation nonalcoholic fatty liver disease
Liver Transpl
(2001)
Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study
Hepatology
Nonalcoholic steatohepatitis: a study of 49 patients
Hum Pathol
Nonalcoholic steatohepatitis: an expanded clinical entity
Gastroenterology
Nutritional status in cirrhosis
J Hepatol
Increased hepatic iron concentration in nonalcoholic steatohepatitis is associated with increased fibrosis
Gastroenterology
Metformin in non-alcoholic steatohepatitis
Lancet
The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years
Hepatology
Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease
Hepatology
Clinical features and natural history of nonalcoholic steatosis syndromes
Semin Liver Dis
Nonalcoholic fatty liver disease: a feature of the metabolic syndrome
Diabetes
Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation
Diabet Med
Cited by (1300)
Hepatic Steatosis After Partial Pancreatectomy in a Cohort of Patients with Intraductal Papillary Mucinous Neoplasm
2023, Journal of Clinical and Experimental HepatologyCT Texture Analysis in Nonalcoholic Fatty Liver Disease (NAFLD)
2023, Journal of Clinical and Experimental HepatologyFatty Liver Disease
2023, MacSween's Pathology of the Liver, Eighth EditionDoes myo-inositol supplementation influence oxidative stress biomarkers in patients with non-alcoholic fatty liver disease?
2024, Food Science and NutritionOne-hour post-load glucose levels are associated with hepatic steatosis assessed by transient elastography
2024, Diabetes, Obesity and MetabolismLow liver fat in non-alcoholic steatohepatitis-related significant fibrosis and cirrhosis is associated with hepatocellular carcinoma, decompensation and mortality
2024, Alimentary Pharmacology and Therapeutics
- ☆
Address requests for reprints to: Elisabetta Bugianesi, M.D, Department of Gastroenterology, Ospedale S. Giovanni Battista, Corso Bramante 88, 10126 Torino, Italy. e-mail: [email protected]; fax: (39) 011-633-5927.