The Liver in Obesity

Zelman, Samuel

doi:10.1001/archinte.1952.00240080007002

Cited by 166 publications

(50 citation statements)

References 23 publications

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“…Saverymuttu et al, 17 in a similar study, also demonstrated a sensitivity of 94% and Fatty liver in obese patients T-J Hsiao et al specificity of 84%. Since the prevalence of fatty liver diagnosed by ultrasonography in our study was 80% in apparently healthy obese subjects, a figure similar to that reported for hospitalized patients and verified by biopsy, 18,19 we believe that our diagnoses were accurate and reliable. As the TYGH IRB would not approve of conducting liver biopsies in apparently healthy obese patients, noninvasive ultrasonographic diagnosis was the most feasible and ethical diagnostic choice.…”

Section: Discussionsupporting

confidence: 89%

Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease in apparently healthy obese patients

Chen

Wang

2003

Int J Obes

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OBJECTIVES:The aims of this study were to test the possible association between nonalcoholic fatty liver disease (NAFLD) and iron and insulin resistance, and to determine the prevalence of NAFLD in apparently healthy obese subjects. DESIGN: Cross-sectional, clinical epidemiologic study. SUBJECTS: A total of 210 apparently healthy obese patients, aged from 18 to 65 y, with a body mass index (BMI) of 28 kg/m 2 or more, were enrolled in a body weight reduction program in our hospital. MEASUREMENTS: All the subjects underwent screening and preprogram examinations, including anthropometric data measurements, biochemistry testing, and ultrasonography of the liver. NAFLD was defined as fatty liver diagnosed by ultrasonograpgy plus persistent elevation of alanine aminotransferase (ALT) levels. RESULTS: Of the 210 patients, 80% (168/210) had fatty liver. Persistent ALT elevation in two separate tests was further detected in 25.6% (43/168) of patients. Multiple logistic regression analysis showed waist circumference and insulin resistance to be independently associated with fatty liver. Serum ferritin level and insulin resistance were two major risk factors predicting NAFLD. CONCLUSION: The prevalence of NAFLD was 20.5% (43/210) in obese patients. As both hyperinsulinemia induced by insulin resistance and iron overload represented by ferritin elevation might damage hepatocytes, we concluded that these two factors were significantly associated with NAFLD in obese patients.

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Section: Discussionsupporting

confidence: 89%

Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease in apparently healthy obese patients

Chen

Wang

2003

Int J Obes

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“…In 1952, Zelman's landmark article carefully characterized hepatic histology in 19 obese subjects, and portal fibrosis was identified in 4 of 19 (21%) subjects without hepatocellular necrosis. 17 In 1973, Kern and colleagues analyzed 151 individuals who underwent bariatric surgery and noted mild periportal fibrosis in 42 (28%) without evidence of hyaline necrosis. 18 Campbell et al demonstrated portal fibrosis in 37% of subjects undergoing jejunoileal bypass for morbid obesity.…”

Section: Resultsmentioning

confidence: 99%

Portal fibrosis and hepatic steatosis in morbidly obese subjects: A spectrum of nonalcoholic fatty liver disease

et al. 2004

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Nonalcoholic steatohepatitis (NASH) is a progressive form of nonalcoholic fatty liver disease (NAFLD) that can lead to hepatic fibrosis and cirrhosis. Portal fibrosis in the absence of NASH, called isolated portal fibrosis (IPF), has received less attention and has not been classified as a spectrum of NAFLD. The aims of this study were to determine the prevalence of IPF in subjects undergoing gastric bypass surgery, to identify biochemical variables associated with IPF, and to assess the metabolic syndrome as defined by the AdultTreatment Panel III criteria. We analyzed liver biopsies from 195 morbidly obese subjects after excluding all other causes of liver disease. The prevalence of fatty liver (FL) only, IPF, and NASH was 30.3%, 33.3%, and 36.4%, respectively. Several biochemical parameters significantly trended across the 3 groups, with IPF falling between FL and NASH. Hyperglycemia was the only metabolic parameter associated with NASH (OR, 5.4; 95% CI, 2.4-12; P < .0001) and IPF (OR, 2.8; 95% CI, 1.2-6.5; P ‫؍‬ .01). Subjects with diabetes had the greatest risk for NASH (OR, 8; 95% CI, 3.3-19.7; P < .0001) and IPF (OR, 4.3; 95% CI, 1.6-11.6; P ‫؍‬ .003). The metabolic syndrome was identified in 78.5% of subjects, and a significant trend for the number of metabolic criteria was observed across the spectrum of FL, IPF, and NASH. In conclusion, a significant subset of morbidly obese individuals has portal fibrosis in the absence of NASH that is associated with glycemic dysregulation. Therefore, IPF should be considered a spectrum of NAFLD that may prelude NASH in morbid obesity. T he prevalence of obesity (body mass index [BMI]Ն30 kg/m 2 ) in the United States. is 31%. 1 Morbid obesity (BMI Ն 40kg/m 2 ), commonly referred to as clinically severe obesity, is increasing at twice the rate of obesity (BMI 30 -39 kg/m 2 ). 2 Therapy for clinically severe obesity includes pharmacotherapy with behavioral counseling or bariatric surgery. To date, bariatric surgery has proven to be the most successful approach. 3 In 1991, the National Institutes of Health published guideline indications for bariatric surgery that included either a BMI Ն40 kg/m 2 or a BMI Ն35 kg/m 2 associated with medical comorbidities such as type 2 diabetes, hypertension, or sleep apnea. 4 Minimally invasive surgery with the laparoscope has significantly improved postoperative morbidity and mortality following Roux-en-Y gastric bypass surgery (RYGBP) and is presently the most common procedure performed for severe obesity. 5

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“…The observation that some obese individuals presented a liver disease histologically indistinguishable from alcoholic liver disease itself had long been recognized. [42][43][44][45][46][47][48][49] Interestingly, it has been recently demonstrated that obesity also increases the risk of liver disease induced by either alcohol 50 or chronic hepatitis C. [51][52][53] In a literature survey of 41 original articles comprising information on liver morphology in 1515 morbidly obese patients, liver biopsy was considered as normal in only 12% of the cases. 54 The most frequent abnormality reported was fatty changes present in 80% of the biopsies; portal inflammation was also common (33%) while portal or periportal fibrosis was observed in 29%.…”

Section: The Association Of Nash With Obesitymentioning

confidence: 99%

Obesity and liver disease

Scheen

Luyckx

2002

Best Practice & Research Clinical Endocrinology & Metab

118

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Non-alcoholic steatohepatitis (NASH) is a disease of emerging identity and importance. It is frequently associated with obesity, especially visceral fat, and is intimately related to fatty liver and markers of the insulin resistance syndrome. Both the prevalence and the severity of liver steatosis are related to body mass index, waist circumference, hyperinsulinaemia, hypertriglyceridaemia and impaired glucose tolerance or type 2 diabetes. The identification of obese patients who may progress from steatosis to NASH and from NASH to fibrosis/cirrhosis is an important clinical challenge. Substantial weight loss is accompanied by a marked attenuation of insulin resistance and related metabolic syndrome and, concomitantly, by a remarkable regression of liver steatosis in most patients, although increased inflammation may be detected in some subjects. Thus, NASH may be considered as another disease of affluence, as is the insulin resistance syndrome, and perhaps being part of it, especially in obese patients.

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The Liver in Obesity

Cited by 166 publications

References 23 publications

Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease in apparently healthy obese patients

Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease in apparently healthy obese patients

Portal fibrosis and hepatic steatosis in morbidly obese subjects: A spectrum of nonalcoholic fatty liver disease

Obesity and liver disease

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