Gastroenterology

Gastroenterology

Volume 118, Issue 6, June 2000, Pages 1117-1123
Gastroenterology

Liver, Pancreas, and Biliary Tract
Liver fibrosis in overweight patients,☆☆

https://doi.org/10.1016/S0016-5085(00)70364-7Get rights and content

Abstract

Background & Aims: A common clinical issue is whether overweight patients with abnormal liver function test results should undergo liver biopsy. Although serious liver injury can occur, its prevalence and risk factors are not well known. Methods: Ninety-three consecutive patients with abnormal liver function tests (but without overt liver disease), body mass index (BMI) > 25 kg/m2, and no alcoholic, viral, autoimmune, drug-induced, or genetic liver disease were retrospectively studied. Clinical, biological, and histological variables were tested for association with septal fibrosis or cirrhosis. Results: Septal fibrosis was present in 28 patients (30%) including cirrhosis in 10 (11%). Age ≥ 50 years (odds ratio [OR], 14.1), BMI ≥ 28 kg/m2 (OR, 5.7), triglycerides ≥ 1.7 mmol/L (OR, 5), and alanine aminotransferase (ALT) ≥ 2N (OR, 4.6) were independently associated with septal fibrosis. Among histological features, septal fibrosis was strongly associated with necroinflammatory activity (OR, 44). A score combining age, BMI, triglycerides, and ALT had 100% negative predictive value for septal fibrosis when scoring 0 or 1 (100% sensitivity for a specificity of 47%). Conclusions: Septal fibrosis occurs frequently in overweight patients with abnormal liver function tests. A clinicobiological score combining BMI, age, ALT, and triglycerides could improve selection of patients for liver biopsy.

GASTROENTEROLOGY 2000;118:1117-1123

Section snippets

Design of the study

This retrospective study included 93 consecutive patients with a body mass index (BMI) higher than 25 kg/m2 for at least 5 years, referred to our clinic between January 1988 and June 1999 for investigation of persistent, unexplained abnormal liver function tests. Abnormal liver function tests were defined as an elevation of alanine aminotransferase (ALT), and/or aspartate aminotransferase (AST), and/or γ-glutamyl transpeptidase (GGT) levels above the upper limit of normal. All patients had a

Study population

Ninety-three consecutive patients fulfilling the inclusion criteria were included in this study. Demographic, clinical, and laboratory data are listed in Table 1. The ranges of ALT, γ-glutamyl transpeptidase (GGT), and AST elevations were 1-6.7, 1-19, and 1-4.7, respectively. Five patients (5%) had normal ALT, 15 (16%) normal GGT, and 36 (39%) normal AST. Six patients (6%) had abnormal ALT alone (normal AST and GGT), 3 (3%) patients had abnormal GGT alone, whereas no patient had abnormal AST

Discussion

The main finding of this study was that 30% of overweight patients with abnormal liver function test results had septal fibrosis, including 11% who had silently progressed to cirrhosis. This high prevalence of septal fibrosis might have been biased by several factors. First, because this study is retrospective, we cannot rule out unknown biases in referral for hepatologic exploration. Therefore, our analysis might not apply as faithfully to all overweight patients with abnormal liver function

Acknowledgements

The authors thank Françoise Leverier and Sandrine Guyon for secretarial assistance and Janet Ratziu for English language assistance.

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    Address requests for reprints to: Vlad Ratziu, M.D., Service d'Hépatogastroenterologie, Hopital Pitié-Salpétrière, 47-83 Bd. de l'Hopital, Paris, 75013 France. e-mail: [email protected]; fax: (33) 1 42 16 14 25.

    ☆☆

    Supported by a grant from the Association Pour la Recherche sur le Cancer (to V.R.).

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