Ninety patients with nonalcoholic steatohepatitis

Insulin resistance, familial tendency, and severity of disease

Ira R. Willner, Bradford Waters, S. Raj Patil, Adrian Reuben, Joseph Morelli, Caroline A. Riely

Research output: Contribution to journalArticle

313 Citations (Scopus)

Abstract

OBJECTIVE: Nonalcoholic steatohepatitis (NASH) is a common but poorly understood liver disease. Our aim was to study a large group of patients referred for Hepatology consultation to further characterize this disorder, in particular its demographics and range of severity. We also sought to better understand its etiology and its relationship to the insulin resistance syndrome, known as the metabolic syndrome or syndrome X. METHODS: Retrospective review of 90 patients seen over a 4-yr period. RESULTS: Ninety patients aged 14-70 with NASH seen at the Liver Clinics at either the University of Tennessee or the Medical University of South Carolina. Eleven had complications of portal hypertension and seven of these had undergone or were awaiting transplantation. NASH was seen in nine families either in siblings or in subsequent generations. Diabetes or insulin resistance were present in almost all in this cohort of patients with NASH. Diabetes, hyperlipidemia, hypertension, and atherosclerotic disease, the components of syndrome X, were common in this population. CONCLUSION: NASH affects males and females equally, and presents over a wide age range. Despite its usually benign course, 28% of patients had cirrhosis and almost half of those had complications of portal hypertension, necessitating liver transplantation. Obesity was common in affected patients and cirrhosis was more common in the morbidly obese. Familial clustering was common, with 18% of patients having a similarly affected first degree relative. The clinical features that define syndrome X (diabetes, hypertension, hyperlipidemia, and atherosclerotic disease) are common in affected patients. Studies of glucose tolerance demonstrated unsuspected diabetes in six, and insulin resistance (the hallmark of syndrome X) in 85% of those tested. We hypothesize that NASH is a disorder of genetic etiology and is the hepatic manifestation of syndrome X, the insulin resistance syndrome.

Original languageEnglish (US)
Pages (from-to)2957-2961
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume96
Issue number10
DOIs
StatePublished - Oct 23 2001

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Insulin Resistance
Metabolic Syndrome X
Portal Hypertension
Hyperlipidemias
Fibrosis
Hypertension
Inborn Genetic Diseases
Non-alcoholic Fatty Liver Disease
Liver
Gastroenterology
Liver Transplantation
Cluster Analysis
Liver Diseases
Siblings
Referral and Consultation
Obesity
Transplantation
Demography
Glucose
Population

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Ninety patients with nonalcoholic steatohepatitis : Insulin resistance, familial tendency, and severity of disease. / Willner, Ira R.; Waters, Bradford; Patil, S. Raj; Reuben, Adrian; Morelli, Joseph; Riely, Caroline A.

In: American Journal of Gastroenterology, Vol. 96, No. 10, 23.10.2001, p. 2957-2961.

Research output: Contribution to journalArticle

Willner, Ira R. ; Waters, Bradford ; Patil, S. Raj ; Reuben, Adrian ; Morelli, Joseph ; Riely, Caroline A. / Ninety patients with nonalcoholic steatohepatitis : Insulin resistance, familial tendency, and severity of disease. In: American Journal of Gastroenterology. 2001 ; Vol. 96, No. 10. pp. 2957-2961.
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abstract = "OBJECTIVE: Nonalcoholic steatohepatitis (NASH) is a common but poorly understood liver disease. Our aim was to study a large group of patients referred for Hepatology consultation to further characterize this disorder, in particular its demographics and range of severity. We also sought to better understand its etiology and its relationship to the insulin resistance syndrome, known as the metabolic syndrome or syndrome X. METHODS: Retrospective review of 90 patients seen over a 4-yr period. RESULTS: Ninety patients aged 14-70 with NASH seen at the Liver Clinics at either the University of Tennessee or the Medical University of South Carolina. Eleven had complications of portal hypertension and seven of these had undergone or were awaiting transplantation. NASH was seen in nine families either in siblings or in subsequent generations. Diabetes or insulin resistance were present in almost all in this cohort of patients with NASH. Diabetes, hyperlipidemia, hypertension, and atherosclerotic disease, the components of syndrome X, were common in this population. CONCLUSION: NASH affects males and females equally, and presents over a wide age range. Despite its usually benign course, 28{\%} of patients had cirrhosis and almost half of those had complications of portal hypertension, necessitating liver transplantation. Obesity was common in affected patients and cirrhosis was more common in the morbidly obese. Familial clustering was common, with 18{\%} of patients having a similarly affected first degree relative. The clinical features that define syndrome X (diabetes, hypertension, hyperlipidemia, and atherosclerotic disease) are common in affected patients. Studies of glucose tolerance demonstrated unsuspected diabetes in six, and insulin resistance (the hallmark of syndrome X) in 85{\%} of those tested. We hypothesize that NASH is a disorder of genetic etiology and is the hepatic manifestation of syndrome X, the insulin resistance syndrome.",
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