Primary biliary cirrhosis is more severe in overweight patients.
OBJECTIVE
We sought to determine whether features of metabolic syndrome (MS) and histologic features of nonalcoholic steatohepatitis (NASH) are associated with increased fibrosis in patients with primary biliary cirrhosis (PBC).


BACKGROUND
PBC is a chronic, progressive cholestatic disease. MS is strongly associated with NASH and fibrosis progression in some liver diseases.


METHODS
Patients with PBC seen consecutively at the University of Miami between 1985 and 2008 who had antimitochondrial antibody positivity and a liver biopsy performed at this center at the time of diagnosis were identified. Demographics, clinical features, and biochemical parameters were collected. All liver biopsies were reviewed by a single blinded pathologist for features of NASH, PBC, and fibrosis. The impact of NASH and features of MS on liver biopsy findings were analyzed.


RESULTS
Forty-nine patients [median age 51 (34 to 78) years, 98% females] were enrolled. Higher degree of steatosis, severe inflammatory grade, and severe biliary duct damage were each associated with advanced fibrosis (P<0.0001). Regarding MS, only overweight status [body mass index (BMI) ≥ 25] was associated with nonalcoholic fatty liver activity score (NAS) ≥ 5 (P<0.0001), biliary duct damage (P<0.0001), and advanced fibrosis (71% vs. 32%, P=0.007). Patients with NAS ≥ 5 had more severe fibrosis (14/15, 96% vs. 11/34, 44%; P=0.0001) and more severe biliary duct damage (13/15, 87% vs. 3/34, 9%; P=<0.0001).


CONCLUSIONS
NASH and BMI ≥ 25 are associated with severe biliary duct damage and fibrosis in patients with PBC. BMI could become a useful noninvasive tool to predict advanced fibrosis in PBC.
Center for Liver Diseases, Division of Hepatology, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Mia
M
Híndi
Cynthia
C
Levy
Claudia A
CA
Couto
Pablo
P
Bejarano
Flavia
F
Mendes
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology; D001706:Biopsy; D015992:Body Mass Index; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000473:pathology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology*; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D050177:Overweight / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method