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Microvesicular Steatosis in Individuals with Obesity: a Histological Marker of Non-alcoholic Fatty Liver Disease Severity

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Abstract

Background

In non-alcoholic fatty liver disease (NAFLD), steatosis can manifest through two distinct forms: macrovesicular (macroS) and microvesicular (microS).

Objective

To investigate the prevalence of microS and its association with biochemical parameters and NAFLD-related histological findings in individuals with obesity.

Methods

This is an observational retrospective cross-sectional study, enrolling individuals who underwent bariatric surgery and liver biopsy at a university hospital. A 1:2 propensity matching was performed to pair microS with isolated macroS; this matching enrolled variables “age,” “gender,” “body mass index (BMI),” and “obesity-associated medical problems.” Clinical, biochemical, and histopathological aspects were then analyzed and compared.

Results

Of 115 participants, 88.7% were female; average age was 40.5 ± 5 years and mean BMI was 37.9 ± 3.3 kg/m2. Steatosis occurred in 82.6% (67.8% isolated macroS and 14.8% microS). MicroS is significantly associated with higher levels of alanine aminotransferase (ALT) (39.8 ± 26.4 vs. 26.7 ± 17.5; p = 0.04) and glucose (103.8 ± 52.6 vs. 83.3 ± 10.8; p = 0.03) and higher frequencies of moderate to severe macroS (41.2% vs. 2.0%; p < 0.001), portal fibrosis (100% vs. 50%; p < 0.001), perisinusoidal fibrosis (100% vs. 55.9%; p < 0.001), lobular inflammation (100% vs. 41.1%; p < 0.001), and portal inflammation (100% vs. 41.1%; p < 0.001). An independently positive association was observed between intensities of microS and macroS (p < 0.001).

Conclusion

MicroS is significantly associated with higher levels of ALT and glucose and higher frequencies of moderate to severe macroS, hepatocellular ballooning, portal fibrosis, perisinusoidal fibrosis, lobular inflammation, and portal inflammation. These findings indicate that microS could be considered a reliable histological marker of NAFLD severity.

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Authors and Affiliations

  1. Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Rua Alexander Fleming, S/No, Cidade Universitária Zeferino Vaz, SP, CEP 13085-000, Campinas, Brazil

    Carlos Wustemberg Germano, Paulo Ferreira Mega, Thiago Jordão Almeida Prado Mattosinho, Martinho Antonio Gestic, Murillo Pimentel Utrini, Felipe David Mendonça Chaim, Francisco Callejas-Neto, Elinton Adami Chaim & Everton Cazzo

  2. School of Medicine, Pontíficia Universidade Católica de Campinas (PUCCAMP), Campinas, Brazil

    Luana Leite Castilho Dias

Authors
  1. Carlos Wustemberg Germano
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  2. Paulo Ferreira Mega
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  3. Thiago Jordão Almeida Prado Mattosinho
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  8. Francisco Callejas-Neto
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Corresponding author

Correspondence to Everton Cazzo.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Work developed at Dept. of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas (SP), Brazil.

Key Points

1. Microvesicular steatosis associated with higher levels of alanine aminotransferase and glucose.

2. Microvesicular steatosis associated with histological hallmarks of non-alcoholic fatty liver disease (NAFLD) progression.

3. The presence of microvesicular steatosis could be considered a reliable histological marker of NAFLD severity in individuals with obesity.

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Germano, C.W., Mega, P.F., Mattosinho, T.J.A.P. et al. Microvesicular Steatosis in Individuals with Obesity: a Histological Marker of Non-alcoholic Fatty Liver Disease Severity. OBES SURG 33, 813–820 (2023). https://doi.org/10.1007/s11695-023-06467-9

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  • DOI: https://doi.org/10.1007/s11695-023-06467-9

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