Analysis of risk factors for fibrosis in biopsy proven NAFLD

Background: Nonalcoholic fatty liver disease (NAFLD) is fast becoming one of the top concerns for clinicians due to the obesity epidemic and it's potential to progress to chronic liver disease which has significant impact on liver-related morbidity and mortality. Advanced fibrosis that accompanies NAFLD leads to the development of Cirrhosis and hepatocellular carcinoma. Objectives: There is a need to identify patients who are likely to have fibrosis. Methods: Two hundred and sixteen cases were selected for liver biopsies taking into account the clinical parameters andorUltrasonographyfindingsof fatty liver. Formalinfixed paraffin embedded tissue sections were stained with Haematoxylin andEosin, Reticulin andMasson's Trichrome.Histopathologic scoringwasdone asperBrunt et al scoringsystem. Result: Out of 216 biopsy proven NAFLD patients, 183 were male and 33 female. On histopathological study, fibrosis was found in 48.216 (22%) cases. On evaluation of metabolic profile, two third (59%) were obese (BMI > 23), 75% had transaminitis, 93% had dyslipidemia, 23% were diabetic and 20% were hypertensive. Inspite of these metabolic derangements, only 36% had moderate fatty change on ultrasonography and rests were mild. Metabolic syndrome was present in only 45% of patients. Conclusion: At present, liver biopsy is the only diagnostic method to detect progression to fibrosis stage in NAFLD cases. Early detection of fibrosis can reverse the pathogenetic mechanism with prompt institution of therapy. Factors associated with fibrosis in our study were higher age i.e, age >40 years, female gender, high BMI >23 and moderate fatty change on ultrasonography.