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Risk factors associated with nonalcoholic fatty liver disease and its relationship with the hepatic histological changes

Rodríguez-Hernández, Heribertoa b; Gonzalez, José L.c; Márquez-Ramirez, Maria Doloresd; Flores-Hernandez, Marissad; Rodríguez-Morán, Marthaa b; Guerrero-Romero, Fernandoa b

European Journal of Gastroenterology & Hepatology: May 2008 - Volume 20 - Issue 5 - p 399-403
doi: 10.1097/MEG.0b013e3282f448af
Original Articles: Fatty Liver

Objective The objective of this study is to determine the association between risk factors and nonalcoholic fatty liver disease (NAFLD), and to establish the relationship between risk factors and hepatic histological changes in obese women.

Methods A case-control design study. Women with NAFLD (cases) were compared with a control group of obese women without NAFLD matched by age, body mass index, waist circumference, and body fat. Irrespective of serum aminotransferases levels, diagnosis of NAFLD was established by the presence of type II diabetes, hypertriglyceridemia, and ultrasonographic changes of hepatic steatosis. Diagnosis of nonalcoholic steatohepatitis was performed by a liver biopsy. Women with an aspartate aminotransferase/alanine aminotransferase (ALT) ratio of at least 1 underwent liver biopsy. Alcohol consumption, hepatitis, and drugs that promote cholestasis or liver injury were the exclusion criteria. Multiple regression analysis was used to compute the association between the risk factors and NAFLD, and Spearman's analysis was used to examine its relationship with histological hepatic changes.

Results A total of 108 obese women were enrolled. The frequency of high blood pressure, hypertriglyceridemia, and diabetes was similar between the groups. ALT (54.4±33.3 and 39.8±29.8, P=0.03) but not aspartate aminotransferase (45.4±23.1 and 36.7±21.2, P=0.06) was significantly higher in the women with NAFLD. The multivariate regression analysis showed a significant association of ALT (odds ratio 2.7; 95% confidence interval, 1.3–10.4), but not other variables with NAFLD. Type II diabetes was strongly correlated with ballooning and inflammation, and ALT with inflammation and fibrosis.

Conclusion Obese women with similar metabolic alterations exhibit different hepatic outcomes. Elevation of ALT, but not other risk factors, was associated with NAFLD. Diabetes and ALT correlate with histological hepatic changes.

aBiomedical Research Unit, Mexican Social Security Institute

bResearch Group on Diabetes and Chronic Illnesses

cDepartment of Pathology

dDepartment of Radiology and Ultrasonography, General Hospital of the Mexican Social Security Institute, Durango, Mexico

Correspondence to Fernando Guerrero-Romero, MD, PhD, FACP, Siqueiros 225 esq/Castañeda, 34000 Durango, Mexico

Fax: +52 618 813 2014; e-mail:

Received 17 May 2007 Accepted 8 November 2007

© 2008 Lippincott Williams & Wilkins, Inc.