title: Silent non-alcoholic fatty liver disease-a clinical-histological study.
abstract: OBJECTIVE
  We studied the prevalence of non-alcoholic fatty liver disease and non-alcoholic-steatohepatitis in patients with metabolic-syndrome but normal liver enzymes. The histological findings of patients with normal liver enzymes and non-alcoholic-steatohepatitis were compared with those of a control-group with persistently abnormal liver enzymes.
  
  
  METHODS
  Patients presenting with normal liver enzymes were enrolled in the study and underwent liver biopsy. Prevalence of non-alcoholic-steatohepatitis and risk factors for fibrosis and cirrhosis were evaluated. Data from a control-group with non-alcoholic-steatohepatitis and abnormal liver enzymes were used to compare the histological findings.
  
  
  RESULTS
  Fifty-eight of the 80 patients enrolled had varying degrees of non-alcoholic steatohepatitis, of these 26 had fibrosis and 8 silent cirrhosis. The association of metabolic-syndrome, female-sex, a long-history of obesity and body mass index>45 were considered to be independent risk-factors for fibrosis. Comparing the histological findings of cases and controls we found a similar severity of steatosis and fibrosis, with a greater prevalence of ballooning degeneration and glycogenated-nuclei rather than lobular-inflammation.
  
  
  CONCLUSIONS
  In the subjects selected according to our criteria, liver enzyme levels could not be used as surrogate markers of non-alcoholic-steatohepatitis. Histological hallmarks of patients with metabolic-syndrome, normal liver enzymes and non-alcoholic-steatohepatitis consist to a lesser degree of lobular-inflammation and a more severe ballooning and glycogenated-nuclei.
authors.affiliation: Section of Hepatology in Internal Medicine, Department of Clinical and Experimental Medicine, Federico II University Medical School, Via S. Pansini 5, 80131 Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sorrentino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tarantino
authors.forename: Paolo
authors.initials: P
authors.lastname: Conca
authors.forename: Alessandro
authors.initials: A
authors.lastname: Perrella
authors.forename: Maria Luigi
authors.initials: ML
authors.lastname: Terracciano
authors.forename: Raffaella
authors.initials: R
authors.lastname: Vecchione
authors.forename: Giovanna
authors.initials: G
authors.lastname: Gargiulo
authors.forename: Nicola
authors.initials: N
authors.lastname: Gennarelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Lobello
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005234:Fatty Liver / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000473:pathology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000473:pathology; D015995:Prevalence