Non-alcoholic fatty liver disease - clinical and histopathological aspects

We conducted a retrospective study on patients who were hospitalized in the Emergency County Hospital of Craiova, Romania, between 2009-2014. We selected 75 patients out of 248 cases of fatty liver disease who underwent liver biopsies performed during surgical procedures for various diagnoses.

We analyzed the patients' data recorded in examination charts: anthropometric parameters [height, weight, body mass index (BMI), abdominal circumference], metabolic lab tests (blood glucose, lipid profile), liver destruction enzymes, imaging examinations (abdominal ultrasound). The pathological study was performed on specimens directly after sampling as well as after staining.

After analyzing the results of the histological examination, we grouped our studied patients according to the degree of the liver steatosis: 21 (28%) cases with mild steatosis, 46 (61.33%) cases with moderate disease and eight (10.66%) cases with severe steatosis. The necrotic-inflammatory activity was mild in 28 (37.33%) cases, moderate in 36 (48%) cases and severe in 11 (14.66%) cases. Most of the studied patients exhibited septal fibrosis (45 cases - 60%) and porto-portal and porto-central bridging fibrosis (21 cases - 28%). Septal fibrosis and cirrhosis were recorded in four (5.33%) and five (6.66%) cases, respectively. There was a significant correlation between the degree of the hepatic steatosis, the degree of obesity (as expressed by BMI) and the waist circumference (as a measure of central obesity) - p<0.001.

The non-alcoholic fatty liver disease (NAFLD) was found to be significantly associated with waist circumference, BMI, triglycerides. The liver enzymes are not considered to be sensitive or specific for diagnosing NAFLD. Concerning the association between the steatosis and fibrosis, in our study the septal fibrosis was associate with mild steatosis in most of the cases. Moderate steatosis was mostly associated with septal fibrosis as well as porto-portal and porto-central fibrosis. Severe steatosis was correlated with both porto-portal and porto-central fibrosis and cirrhosis in the majority of cases.