title: Ninety patients with nonalcoholic steatohepatitis: insulin resistance, familial tendency, and severity of disease.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, USA.
authors.forename: I R
authors.initials: IR
authors.lastname: Willner
authors.forename: B
authors.initials: B
authors.lastname: Waters
authors.forename: S R
authors.initials: SR
authors.lastname: Patil
authors.forename: A
authors.initials: A
authors.lastname: Reuben
authors.forename: J
authors.initials: J
authors.lastname: Morelli
authors.forename: C A
authors.initials: CA
authors.lastname: Riely
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D048909:Diabetes Complications; D005234:Fatty Liver / Q000150:complications / Q000235:genetics / Q000503:physiopathology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D012720:Severity of Illness Index