Fatty liver hepatitis (steatohepatitis) and obesity: An... : Hepatology (original) (raw)
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Fatty liver hepatitis (steatohepatitis) and obesity: An autopsy study with analysis of risk factors
1_Department of Pathology, University of Toronto, Toronto, Canada, M5G 2C4_
2_Department of Pathology, Toronto East General and Orthopaedic Hospital, 825 Coxwell Avenue, Toronto, Canada, M4C 3E7_
*Address reprint requests to: Department of Pathology, Toronto General Hospital, 200 Elizabeth Street, Toronto, Canada, M5G 2C4
Received October 23, 1989; accepted June 04, 1990; previously published online December 06, 2005
Abstract
Steatohepatitis (fatty liver hepatitis), histologically identical to alcoholic disease, occurs in some obese patients after jejunoileal bypass. A similar lesion occurs rarely in obese patients without bypass surgery, but the risk factors are poorly understood. Hepatic steatosis, steatohepatitis and fibrosis were sought in 351 apparently nonalcoholic patients at autopsy and various risk factors were evaluated. Incidence of steatosis and steatohepatitis correlated with the degree of obesity. Steatohepatitis was found in 18.5% of markedly obese patients and 2.7% of lean patients. Additional risk factors for steatohepatitis were type II diabetes, weight loss in the preterminal period shortly before death and intravenous glucose therapy in the last week of life. Severe fibrosis was found in 13.8% of markedly obese patients and in 6.6% of lean patients; this difference was largely explained by the higher prevalence of diabetes in obese groups.
The risk factors defined in this study are known to be associated with abnormalities of free fatty acid metabolism. Obesity, type II diabetes and intravenous glucose therapy are associated with hyperinsulinemia, which may inhibit fatty acid oxidation. Obesity and weight loss increase the presentation of fatty acids to the liver. Similar metabolic changes may occur in obese patients after jejunoileal bypass surgery. Thus this study supports the hypothesis that fatty acids have a role in the hepatocellular necrosis found in some obese individuals. (HEPATOLOGY 1990;12:1106-1110).
Copyright © 1990 American Association for the Study of Liver Diseases.