Vol. 2, Issue 9, Part L (2016)

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is the accumulation of lipid, primarily in the form of triacylglycerol’s in individuals who do not consume significant amounts of alcohol and other known causes of steatosis, such as certain drugs and toxins, have been excluded. The rising incidence of obesity is associated with health complications. The non-alcoholic fatty liver disease is increasingly being recognized as a major cause of liver-related morbidity and mortality among 15-40% of the general population. Currently, a liver biopsy is the gold standard method for diagnosing NAFLD. Ultrasonography is relatively inexpensive and widely available in clinical settings. NAFLD is considered to be an integral part of the metabolic syndrome. The present study is designed to study the clinical profile of patients with NAFLD with varying degrees of severity as diagnosed by Ultrasonography and evaluate the relationship between the non-alcoholic fatty liver disease and the metabolic syndrome along with its individual components, as defined by the modified NCEP ATP III criteria. Presently there are no lab markers nor imaging modalities which can be relied upon for making the diagnosis. Similarly no clinical signs or symptoms can be relied upon as most of the pts are asymptomatic or may have vague and constitutional symptoms. This study is to analyze the presence of non-alcoholic Steato Hepatitis (NASH) by performing liver biopsy in non-alcoholic adults with evidence of fatty liver on abdominal ultrasonography and to study the association of NASH with other co-morbid conditions.

Methods: The study was conducted on 100 adult patients attending Dept. of Internal Medicine, Al-Ameen Medical College and District Hospital Bijapur with fatty liver on abdominal USG. Inclusion and exclusion criteria’s were applied upon. Detailed history and clinical examination was done. Liver biopsy and other relevant investigations were done.

Results: NASH was found in 16% of the patients with mean age of 48.38 years. Majority of patients with NASH were female and all the patients had BMI >25kg/m². Diabetes mellitus was seen in 50% of NASH patients. 90% had increased serum triglycerides, all with severe NASH were diabetic and hypertensive. AST: ALT ratio was more than 1 as the disease progressed and both the enzymes were elevated in all the patients with NASH irrespective of severity. Hyperbilirubinemia and decreased platelet count was seen in severe forms.

Conclusion: NASH represents a severe form in spectrum of NAFLD, common in 5th decade and mostly asymptomatic with obesity, DM, hypertriglyceridemia as risk factors. Distinction between NASH and steatosis cannot be made reliably on clinical grounds or imaging. Diagnosis can be made with certainty only by examination of liver histology and is a diagnosis of exclusion.