Nonalcoholic fatty liver disease (NAFLD) is a spectrum of disorders ranging from simple fatty liver to steatonecrosis and nonalcoholic steatohepatitis. It is associated with obesity, type II diabetes mellitus, hyperlipidemia, jejunoileal bypass and certain medications, but NAFLD can occur without identifiable risk factors . Patients typically present with unexplained chronic elevation of liver enzymes. Without treatment, a small number of patients with NAFLD develop cirrhosis . This process is accelerated by the presence of HCV and iron overload.
There are no direct correlations among the histological findings, liver enzyme abnormalities, radiological findings and the presence of obesity, hyperlipidemia or diabetes mellitus . Necroinflammatory changes on biopsy, however, may indicate an aggressive course with progression to liver cirrhosis . Therefore, many hepatologists advocate liver biopsy for all patients with abnormal liver enzymes who are suspected of having NAFLD.
Day proposed the following indications for liver biopsy in patients with suspected NAFLD:
• alanine aminotransferase levels more than twice the upper limit of normal
• aspartate aminotransferase greater than alanine aminotransferase
• risk factors, including ‘moderate’ central obesity, noninsulin dependent diabetes mellitus, hypertension and hypertriglyceridemia
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