TY - JOUR T1 - Challenges in the hepatic histopathology in non-alcoholic fatty liver disease JF - Gut JO - Gut SP - 1539 LP - 1540 DO - 10.1136/gutjnl-2016-313379 VL - 66 IS - 9 AU - Elizabeth M Brunt AU - David E Kleiner Y1 - 2017/09/01 UR - http://gut.bmj.com/content/66/9/1539.abstract N2 - Bedossa et al1 present a cross-sectional clinicopathological correlation study of 798 consecutively prospectively obtained liver biopsies from patients who underwent bariatric surgery for severe obesity (body mass index >40 or >35 kg/m2 in whom at least one obesity-related comorbidity existed). Clinical phenotyping included body weight and composition by dual-emission X-ray absorptiometry (DXA), relative and total body fat mass, limb fat measurements and fasting venous samples for liver, glucose and insulin tests. Diabetes and metabolic syndrome were defined according to international criteria, and 84% of subjects also had abdominal subcutaneous fat needle aspiration biopsies. The latter were analysed for adipocyte size and volume by published methods.2As expected, the majority of subjects were women (78%), and Caucasian (73.5%). A range of liver histology was found, including 141 (18%) with ‘no’ (grade 0) steatosis (0%–5%) and no other lesions, and 38 (5%) with grade 0 steatosis, but with either inflammation, ballooning or mild fibrosis. Thus, 77.5% of subjects in the study had some form of non-alcoholic fatty liver disease (NAFLD), and the authors detailed the findings according to the Fatty Liver Inhibition of Progression (FLIP) European Consortium scoring system3 ,4 further discussed below.Several interesting findings resulted from this careful study. In spite of similar durations of obesity, younger individuals had less severe liver disease (most were categorised as ‘presumably normal’) compared with their older counterparts (whose biopsies showed the full spectrum of fatty liver including non-alcoholic steatohepatitis (NASH) and cirrhosis). The younger cohort was more often female (92% vs 73%), but less often Caucasian (40% vs 81%). … ER -