Portal inflammation is associated with advanced histological changes in alcoholic and non-alcoholic fatty liver disease

Rakha, Emad A.; Adamson, Louise; Bell, Emily C.; Neal, Keith; Ryder, Stephen; Kaye, Philip; Aithal, Guruprasad P.

doi:10.1136/jcp.2010.079145

Cited by 53 publications

(54 citation statements)

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“…Here we found about half of patients with NAFLD showing more than mild portal inflammation and interface hepatitis. These percentages are slightly higher than those reported in previous studies in NAFLD,5 6 likely due to different grading criteria for portal inflammation. Among the NAS histological components, portal inflammation was significantly associated with lobular inflammation and ballooning, while it was not associated with steatosis.…”

Section: Discussioncontrasting

confidence: 79%

“…Traditionally, the key characteristic features of NAFLD have been noted in centrolobular location, which may be consistent with the metabolic zonation within the liver acinus,3 while periportal changes have been less frequently described, as discussed by Vespasiani-Gentilucci et al 4. More recently, portal tract inflammation has gained the attention of NAFLD investigators, being recognised in a significant proportion of cases and, even more importantly, showing a strong association with the advanced forms of disease 5 6. However, the determinants of portal inflammation during NAFLD and the mechanisms subtending its association with advanced fibrosis still remain to be elucidated.…”

Section: Introductionmentioning

confidence: 90%

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Portal inflammation during NAFLD is frequent and associated with the early phases of putative hepatic progenitor cell activation

et al. 2015

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Section: Discussioncontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 90%

Portal inflammation during NAFLD is frequent and associated with the early phases of putative hepatic progenitor cell activation

et al. 2015

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“…Although fibrosis may be present in the absence of NASH, it is a worrisome feature on liver biopsy in NAFLD as indicates a more advanced liver disease. In addition, portal inflammation which is not a component of the NAS, has been associated with more severe histological injury and fibrosis in cross-sectional studies suggesting portal inflammation may be indicative of a worse prognosis [15,16]. However, it remains uncertain what long-term prognostic information can be obtained from grading the different histological features and from staging the disease in an individual patient with NAFLD.…”

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confidence: 99%

Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease

et al. 2015

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Background & Aim Histologic analysis of liver biopsies allows for grading and staging of nonalcoholic fatty liver disease (NAFLD). We performed a longitudinal study to investigate the long-term prognostic relevance of histologic features for patients with NAFLD. Methods We performed a retrospective analysis of 619 patients diagnosed with NAFLD from 1975 through 2005 at medical centers in the United States, Europe, and Thailand. Patients underwent laboratory and biopsy analyses, and were examined every 3–12 months after their diagnosis. Outcomes analyzed were overall mortality, liver transplantation, and liver-related events. Cumulative outcomes were compared by log-rank analysis. Cox proportional-hazards regression was used to estimate adjusted hazard ratios (HR). Time at risk was determined from the date of liver biopsy to the date of outcome or last follow-up examination. Results Over a median follow-up of 12.6 years (range 0.3–35.1), 193 of the patients (33.2%) died or underwent liver transplantation. Features of liver biopsies significantly associated with death or liver transplantation included fibrosis stage 1 (HR, 1.88; 95% CI, 1.28, 2.77), stage 2 (HR, 2.89; 95% CI, 1.93, 4.33), stage 3 (HR, 3.76; 95% CI, 2.40, 5.89), and stage 4 (HR, 10.9; 95% CI, 6.06, 19.62) compared with stage 0, as well as age (HR, 1.07; 95% CI, 1.05, 1.08), diabetes (HR, 1.61; 95% CI, 1.13, 2.30), current smoking (HR, 2.62; 95% CI, 1.67, 4.10) and statin use (HR, 0.32; 95% CI, 0.14, 0.70). Twenty-six patients (4.2%) developed liver-related events; fibrosis stage 3 (HR 14.2 [95% CI 3.38, 59.68]) and stage 4 (HR 51.5 [95% CI 9.87, 269.2]) compared to stage 0, were significantly associated with the events. Patients with fibrosis, regardless of steatohepatitis or NAFLD activity score, had shorter survival times than patients without fibrosis. Conclusions In a longitudinal study of patients with NAFLD, fibrosis stage, but no other histologic features of steatohepatitis, were independently associated with long-term overall mortality, liver transplantation, and liver-related events.

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“…Differences in reactivity between GGT and ALT regarding the severity of NAFLD are unclear. GGT levels were found to be significantly higher in alcoholic fatty liver than in NAFLD; by contrast, there was no significant difference in ALT levels between these 2 types of fatty liver [30]. GGT is strongly influenced by the consumption of only a small volume of alcohol [29], and GGT is more sensitive to liver diseases than ALT [31].…”

Section: Discussionmentioning

confidence: 99%

Serum γ-Glutamyltransferase Level is Associated with Periodontal Disease Independent of Drinking Habits in Japanese Adults

Morita¹,

Yamazaki²,

Fujiharu³

et al. 2014

Med Sci Monit

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BackgroundNon-alcoholic fatty liver disease is considered a hepatic manifestation of metabolic syndrome. Periodontal disease is a mild chronic inflammatory disease with systemic effects, and many studies have indicated an association between metabolic syndrome and periodontitis. In the present study, we investigated the relationship between periodontitis and liver biochemical parameters according to alcohol drinking habits through a cross-sectional study based on data from Japanese people in occupational settings.Material/MethodsThe subjects were 1510 employees (1218 males, 292 females, mean age 50.4 years) who underwent dental and medical checkups in 2012. Associations between the presence of periodontal pockets and serum levels of liver biochemical parameters were assessed.ResultsAlanine aminotransferase (ALT) and γ-glutamyltransferase (GGT) levels were higher in subjects with than without periodontal pockets. Multiple logistic regression analysis (adjusting for age, gender, cigarette smoking, and alcohol drinking habits, and components of metabolic syndrome) with GGT or ALT as the dependent variable revealed that there was a significant association between periodontal pockets and GGT (odds ratio, OR=1.48), but not ALT. Similar associations were observed when an analysis was performed according to the presence or absence of alcohol drinking habits; the OR was higher in subjects without (OR=1.84) than with drinking habits (OR=1.41).ConclusionsThe presence of periodontal pockets was associated with serum levels of GGT, a liver biochemical parameter, in Japanese adults with no drinking habit, suggesting that periodontal disease is associated with liver function, independent of alcohol ingestion.

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Portal inflammation is associated with advanced histological changes in alcoholic and non-alcoholic fatty liver disease

Abstract: Portal inflammation is a common component of histological spectrum of both AFLD and NAFLD. In both conditions portal inflammation is associated with clinical and histological features suggestive of advanced disease.

Cited by 53 publications

References 50 publications

Portal inflammation during NAFLD is frequent and associated with the early phases of putative hepatic progenitor cell activation

Portal inflammation during NAFLD is frequent and associated with the early phases of putative hepatic progenitor cell activation

Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease

Serum γ-Glutamyltransferase Level is Associated with Periodontal Disease Independent of Drinking Habits in Japanese Adults

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