Obesity and related parameters of non-alcoholic steatohepatitis.

BACKGROUND/AIMS The aim of this prospective study was to evaluate the clinical, biochemical and histopathological parameters of nonalcoholic steatohepatitis and the conditions associated with this disease. METHODS Twenty-four patients were included in the study, each having been diagnosed with nonalcoholic steatohepatitis on the basis of liver biopsy and elimination of other possible causes of elevated aminotransferase levels. Measurements of degree of obesity, liver enzymes and serum lipids were recorded before liver biopsy and reevaluated after one or two months of a standard exercise and diet program. Serum insulin levels were also measured. Each liver biopsy was histologically examined for steatosis, inflammation, fibrosis, necrosis and iron storage, and semiquantitave assessment of these was recorded for three separate hepatic zones. RESULTS The prevalence of obesity in the group was 79.2%, while the figure for overt and latent diabetes mellitus combined was 33.3%, and for hyperlipidemia was 83.3%. Compared to the rest of the group, the patients with severe steatosis had significantly higher serum lipid (particularly high triglyceride) and insulin levels (p<0.05 for both). There was a correlation between steatosis and obesity (p=0.06). More severe obesity, higher insulin and elevated aspartate aminotransferase were positively correlated with inflammation, whereas elevated serum triglyceride was negatively correlated with inflammation. There was a tendency towards normalization of liver enzyme levels after weight loss and dietary restrictions. CONCLUSIONS Obesity and hyperlipidemia were associated with nonalcoholic steatohepatitis in the group studied. Obesity is not a factor in every case, but the study showed that restricted diet and exercise are significant forms of therapy for nonalcoholic steatohepatitis.