Clinical, biochemical and histological characteristics of a Sri Lankan population of non-alcoholic steatohepatitis (NASH) patients

Abstract

BACKGROUND: Non-alcoholic steatohepatitis (NASH) is common and can progress to cirrhosis. It has been regarded as a 'disease of affluence' and there are only a few reports from developing countries. OBJECTIVE: To describe the clinical, biochemical, and histological characteristics of a cohort of NASH patients in Sri Lanka, and to determine their short term outcome following modifications of lifestyle. METHOD: Patients who had a liver biopsy for investigation of raised hepatic enzymes were assessed during the period May 1999 - May 2003. Patients who had an alcohol intake of over 40 g/week were excluded. Detailed clinical and biochemical data of patients with histologically confirmed NASH were compiled. Histological grading and staging was done using the Brunt system. The patients were advised on lifestyle modifications and the control of diseases known to be associated with NASH. They were followed up at 3 -monthly intervals. RESULTS: During the study period liver biopsies were performed on 296 patients and 100 ( 35.1%) were diagnosed as having NASH. (Men = 79, Mean age 37.2 years, SD 10.6). Risk factors for NASH included diabetes mellitus (55%), obesity (52%), hyperlipidaemia (54%), a family history of risk factors (66%) and a high dietary fat intake (66%). However, 44.3% of men and 33.3% of women were not overweight. Thehistological grading and staging of 80 biopsies showed Grade 1 in 31 (38.8%), Grade 2 in 29 (36.3%), Grade 3 in 20 (25%), Stage 1 in 57 (71.3%) Stage 2 in 13 (16.3%), Stage 3 in 2 (2.5%) and Stage 4 in 8 (10%). In 55/91 (60.4%) patients who were followed up for a median of 2.5 years (range 1-4 years) the serum transaminases returned to normal in a median of 7 months (range 3-14 months). CONCLUSION: The clinical, biochemical and histological features of NASH patients in our series are similar to that reported in western countries. However "lean males" accounted for a significant proportion. In the short term a majority of patients showed improvement in serum transaminases with lifestyle modification.