Digestive Diseases and Sciences

, Volume 51, Issue 10, pp 1725–1729

Predictors of Cirrhosis in Hispanic Patients with Nonalcoholic Steatohepatitis

  • Waleed M. Alazmi
  • Arie Regev
  • Enrique G. Molina
  • Eugene R. Schiff
Original Paper

Abstract

It is estimated that 43% of patients with nonalcoholic steatohepatitis (NASH) will progress to liver fibrosis or cirrhosis. Although NASH is more common in Hispanics, most studies have been conducted on Caucasians, and there is scarce information regarding ethnic differences in this disease. The aim of this study was to identify the independent predictors of cirrhosis in Hispanic patients with NASH. A retrospective case-control study was conducted on 80 patients with biopsy-proven NASH. Forty-two were Hispanic (study group) and 38 were Caucasians controlled for age and BMI (control group). Clinical, biochemical, and histologic features were analyzed for correlation with cirrhosis. There were no significant differences in demographic features between the two groups. In multivariate analysis, independent predictors of cirrhosis among Hispanic patients were age (OR, 1.07; 95% CI, 1.01–1.14) and AST/ALT ratio (OR, 10.56; 95% CI; 2.46–45.29), while independent predictors among non-Hispanic patients were age (OR, 1.085; 95% CI, 1.0–1.186), and diabetes mellitus (OR, 6.46; 95% CI, 1.19–35.07). In patients with NASH, predictors of cirrhosis varied according to ethnic background. Age was an independent predictor in both groups, however, AST/ALT ratio was found to be an independent predictor of cirrhosis only in Hispanic patients, and diabetes mellitus only in non-Hispanic patients.

Keywords

Nonalcoholic steatohepatitis Nonalcoholic fatty liver disease Fibrosis Cirrhosis Hispanics Caucasians 

References

  1. 1.
    Contos MJ, Sanyal AJ (2002) The clinicopathologic spectrum and management of nonalcoholic fatty liver disease. Adv Anat Pathol 9:37–51PubMedCrossRefGoogle Scholar
  2. 2.
    Youssef W, McCullough AJ (2002) Diabetes mellitus, obesity, and hepatic steatosis. Semin Gastrointest Dis 13:17–30PubMedGoogle Scholar
  3. 3.
    Angulo P (2002) Nonalcoholic fatty liver disease. N Engl J Med 346:1221–1231PubMedCrossRefGoogle Scholar
  4. 4.
    Bellentani S, Tiribelli C, Saccoccio G, Sodde M, Fratti N, De Martin C (1994) Prevalence of chronic liver disease in the general population of northern Italy: the Dyonisos study. Hepatology 20:1442–1449PubMedCrossRefGoogle Scholar
  5. 5.
    Weston SR, Leyden W, Murphy R, Bass NM, Bell BP, Manos MM, Terrault NA (2005) Racial and ethnic distribution of nonalcoholic fatty liver in persons with newly diagnosed chronic liver disease. Hepatology 41(2):372–379PubMedCrossRefGoogle Scholar
  6. 6.
    Lee RG (1979) Non-alcoholic steatohepatitis: a study of 49 patients. Hum Pathol 20:594–598CrossRefGoogle Scholar
  7. 7.
    Powell EE, Cookesley EGE, Hanson R, et al. (1990) The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 11:74–80PubMedGoogle Scholar
  8. 8.
    Bacon BR, Farahvash MJ, Janney CG, et al. (1994) Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 107:1103–1109PubMedGoogle Scholar
  9. 9.
    Abdelmalek M, Ludwig J, Lindor KD (1995) Two cases from the spectrum of non-alcoholic steatohepatitis. J Clin Gastroenterol 20:127–130PubMedCrossRefGoogle Scholar
  10. 10.
    Cadwell S, Oelsner D, Iezzoni J, Hespenheide E, Battle E, Driscoll C (1999) Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 29:664–669CrossRefGoogle Scholar
  11. 11.
    McCullough AJ (2002) Update on nonalcoholic fatty liver disease. J Clin Gastroenterol 34(3):255–262PubMedCrossRefGoogle Scholar
  12. 12.
    Garcia-Monson C, Martin-Perez E, Iacono OL, Fernandez-Bermejo M, Majano PL, Apolinario A (2000) Characterization of pathogenic and prognostic factors of nonalcoholic steatohepatitis associated with obesity. J Hepatol 33:716–724CrossRefGoogle Scholar
  13. 13.
    Dixon JB, Bhathal PS, O’Brien PE (2001) Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 121:91–100PubMedCrossRefGoogle Scholar
  14. 14.
    Chitturi S, Weltman M, Farrell GC, McDonald D, Kench J, Liddle C (2002) HFE mutations, hepatic iron, and fibrosis: ethnic-specific association of NASH with C282Y but not with fibrotic severity. Hepatology 36:142–149PubMedCrossRefGoogle Scholar
  15. 15.
    Harrison SA, Oliver DA, Torgerson S, Hayashi P, Neuschwander-Tetri B (2003) NASH: clinical assessment of 501 patients from two separate academic medical centers with validation of a clinical scoring system for advanced hepatic fibrosis. Hepatology 34:511CrossRefGoogle Scholar
  16. 16.
    Angulo P, Keach J, Batts K, Lindor K (1999) Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 30:1356–1362PubMedCrossRefGoogle Scholar
  17. 17.
    Marceau P, Biron S, Hould F, Marceau S, Biron S (1999) Liver pathology and metabolic syndrome X in severe obesity. J Clin Endocrinol Metab 84:1513–1517PubMedCrossRefGoogle Scholar
  18. 18.
    Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I (2000) Liver fibrosis in overweight patients. Gastroenterology 118:1117–1123PubMedCrossRefGoogle Scholar
  19. 19.
    Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 20(7):1183–1197Google Scholar
  20. 20.
    National Cholesterol Education Program (1994) Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation 89(3):1333–1445Google Scholar
  21. 21.
    Brunt EM, Janney CG, Di Bisceglie AM, Neuchwander-Tetri BA, Bacon BR (1999) Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 94:2467–2474PubMedCrossRefGoogle Scholar
  22. 22.
    Brunt EM (2004) Nonalcoholic steatohepatitis. Semin Liver Dis 24(1):3–20PubMedCrossRefGoogle Scholar
  23. 23.
    Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ (1999) Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 116:1413–1419PubMedCrossRefGoogle Scholar
  24. 24.
    Nonomura A, Mizukami Y, Unoura M, Kobayashi K, Takeda Y, Takeda R (1992) Clinicopathologic study of alcohol-like liver disease in non-alcoholics; non-alcoholic steatohepatitis and fibrosis. Gastroenterol Jpn 27:521–528PubMedGoogle Scholar
  25. 25.
    el Hassan AY, Ibrahim EM, al Mulhim FA, Nabhan AA, Chammas MY (1992) Fatty infiltration of the liver: analysis of prevalence, radiological and clinical features and influence on patient management. Br J Radiol 65:774–778PubMedCrossRefGoogle Scholar
  26. 26.
    Clark JM, Diehl AM (2003) Nonalcoholic fatty liver disease: an under-recognized cause of cryptogenic cirrhosis. JAMA 289:3000–3004PubMedCrossRefGoogle Scholar
  27. 27.
    Charlton M (2004) Nonalcoholic fatty liver disease: a review of current understanding and future impact. Clin Gastroenterol Hepatol 2(12):1048–1058PubMedCrossRefGoogle Scholar
  28. 28.
    Wanless IR, Lentz JS (1990) Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 12:1106–1110PubMedGoogle Scholar
  29. 29.
    Wang J, Thornton JC, Burastero S, et al. (1996) Comparisons for body mass index and body fat percent among Puerto Ricans, blacks, whites and Asians living in the New York City area. Obes Res 4:377–384PubMedGoogle Scholar
  30. 30.
    Kral JG, Schaffner F, Pierson RN Jr, Wang J (1993) Body fat topography as an independent predictor of fatty liver. Metabolism 42:548–551PubMedCrossRefGoogle Scholar
  31. 31.
    Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL (1998) Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord 22:39–47PubMedCrossRefGoogle Scholar
  32. 32.
    Casas YG, Schiller BC, DeSouza CA, Seals DR (2001) Total and regional body composition across age in healthy Hispanic and white women of similar socioeconomic status. Am J Clin Nutr 73:13–18PubMedGoogle Scholar
  33. 33.
    Struben VMD, Hespenheide EE, Caldwell SH (2000) Nonalcoholic steatohepatitis and cryptogenic cirrhosis within kindreds. Am J Med 108:9–13PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Waleed M. Alazmi
    • 1
  • Arie Regev
    • 2
  • Enrique G. Molina
    • 2
  • Eugene R. Schiff
    • 2
  1. 1.Division of Gastroenterology, Center for Liver DiseasesUniversity of Miami Leonard M. Miller School of MedicineMiamiUSA
  2. 2.Division of Hepatology, Center for Liver DiseasesUniversity of Miami Leonard M. Miller School of MedicineMiamiUSA

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