title: Clinical significance of serum autoantibodies in patients with NAFLD: results from the nonalcoholic steatohepatitis clinical research network.
abstract: OBJECTIVE
  Some studies have suggested that autoantibodies might define a subcategory and phenotype of nonalcoholic fatty liver disease (NAFLD) associated with advanced histological features. We evaluated the relationship between the presence of serum autoantibodies and liver histology in a large cohort of well-characterized patients with NAFLD.
  
  
  METHODS
  A total of 864 NAFLD patients participating in two prospective multicentre clinical studies underwent testing for serum autoantibodies within 24 months of a liver biopsy. Liver histology was compared between the patients with and without ANA ≥ 1:160 or ASMA ≥ 1:40 or both.
  
  
  RESULTS
  Autoantibodies were present in 182 patients (21%). There was no difference in age, gender, race, body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR), or history of diabetes between the two groups. Biopsies in subjects with autoantibodies were less likely to have moderate-to-severe steatosis (i.e., >33%) compared to controls (57.1 vs. 43.0%, P value = 0.0006). Lobular inflammation (46.7 vs. 47.5%), ballooning degeneration (38.5 vs. 42.5%), and advanced fibrosis (33.2 vs. 29.3%) were not different between the two groups. Histologic evidence of 'definite' NASH did not differ significantly between the two groups (55.5 vs. 58.9%). After adjusting for age, gender, BMI, race, and diabetes, the presence of autoantibodies was independently associated with lower prevalence of moderate-to-severe steatosis [odds ratio (OR), 0.58; 95% confidence interval (CI), 0.41-0.82; P = 0.01].
  
  
  CONCLUSIONS
  Autoantibodies are frequently positive in NAFLD in the absence of autoimmune hepatitis and their occurrence is not associated with more advanced histologic features.
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA. rvuppala@iupui.edu.
authors.forename: Raj
authors.initials: R
authors.lastname: Vuppalanchi
authors.affiliation: Centre for Liver Disease, Virginia Mason Medical Centre, Seattle, WA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gould
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Wilson
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Aynur
authors.initials: A
authors.lastname: Unalp-Arida
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Oscar W
authors.initials: OW
authors.lastname: Cummings
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Naga
authors.initials: N
authors.lastname: Chalasani
authors.affiliation: Centre for Liver Disease, Virginia Mason Medical Centre, Seattle, WA, USA.
authors.forename: Kris V
authors.initials: KV
authors.lastname: Kowdley