title: Nonalcoholic steatohepatitis in nonalcoholic fatty liver disease patients of Bangladesh.
abstract: OBJECTIVE
  To explore the prevalence and risk factors for nonalcoholic steatohepatitis (NASH) in nonalcoholic fatty liver disease (NAFLD) patients.
  
  
  METHODS
  We have included 493 patients with sonographic evidence of a fatty change, and 177 of these individuals were evaluated and confirmed after liver biopsy. The exclusion criteria consisted of significant alcohol abuse (< 20 g daily), evidence of hepatitis B and C, evidence of drug-induced fatty liver disease and other specific liver diseases such as hemochromatosis, Wilson's disease or autoimmune liver disease. The patients were assessed for metabolic syndrome, and biochemical, anthropometric and histopathological evaluations were carried out. The degree of disease activity in the NAFLD patients was evaluated using the NAFLD Activity Score. The data were analyzed by SPSS, version 16.0.
  
  
  RESULTS
  Females predominated among the study participants (250, 57.0%), and the mean age was 40.8 ± 10.2 years. The numbers of overweight, obese I and obese II patients were 58 (13.2%), 237 (53.9%) and 93 (21.2%), respectively. However, there were 422 (96.2%) centrally obese patients. NASH was absent in 10 (5.6%) cases, borderline in 92 (52.6%) cases and present in 75 (42.4%) cases. The presence of diabetes could significantly (P = 0.001) differentiate NASH from simple steatosis. The following parameters did not influence the development of NASH: age, sex, basal metabolic index, waist circumference, serum high-density lipoprotein, triglyceride, insulin resistance index, hypertension and metabolic syndrome. The serum gamma-glutamyl transpeptidase (GGT) level was significantly higher (P = 0.05, 51.7 ± 32.8 and 40.4 ± 22.6 U/L) in the NASH patients, with a sensitivity of 45% and a specificity of only 68%. The serum alanine aminotransferase and aspartate aminotransferase levels were not able to predict NASH.
  
  
  CONCLUSIONS
  Females were the predominant sufferers of NAFLD in Bangladesh. The prevalence of NASH was high. Diabetes was found to be the main culprit in developing NASH. GGT was the only biochemical marker of NASH. We recommend liver biopsy in NAFLD patients who have diabetes and elevated GGT.
authors.affiliation: Shahinul Alam, Sheikh Mohammad Noor-E-Alam, Ziaur Rahman Chowdhury, Mahabubul Alam, Jahangir Kabir, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh.
authors.forename: Shahinul
authors.initials: S
authors.lastname: Alam
authors.forename: Sheikh Mohammad
authors.initials: SM
authors.lastname: Noor-E-Alam
authors.forename: Ziaur Rahman
authors.initials: ZR
authors.lastname: Chowdhury
authors.forename: Mahabubul
authors.initials: M
authors.lastname: Alam
authors.forename: Jahangir
authors.initials: J
authors.lastname: Kabir
keywords: Alanine aminotransferase; Basal metabolic index; Fatty liver; Gamma-glutamyl transpeptidase; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Obesity