title: Prevalence of non-alcoholic fatty liver disease in four different weight related patient groups: association with small bowel length and risk factors.
abstract: BACKGROUND
  Non-alcoholic steatohepatitis (NASH) is an obesity associated common cause of liver inflammation and there are concerns that it may turn out to be the most common cause of liver failure as prevalence of obesity increases. We determined the prevalence of NASH in relation to gender and body mass index (BMI). Furthermore, we assessed the association of NASH with the length of the small bowel.
  
  
  METHODS
  124 liver samples obtained during routine operations were examined looking for NAFLD Activity Score (nonalcoholic fatty liver disease). The length of small bowel was measured intraoperatively. For evaluation, patients were divided into four groups according to their BMI (group 1: normal weight, group 2: overweight, group 3: grade I/II morbidly obese, and group 4 grade III morbidly obese patients).
  
  
  RESULTS
  BMI showed a strong positive correlation with risk of NASH and a weak positive correlation with small bowel length. No normal weight patient was at risk of NASH, whereas in group 2 14% had uncertain and 32% definite NASH. In group 3 11% had uncertain and 27% definite NASH. In group 4 nearly two-thirds were classified as uncertain or definite NASH. Median length of small bowel in all patients was 450 cm (range 226-860 cm). Within group 4, patients with definite/uncertain NASH had a longer small bowel than patients without NASH.
  
  
  CONCLUSIONS
  Prevalence of NASH is high in morbidly obese. Small bowel length could influence the complex etiology of the disease.
authors.affiliation: Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany. Andreas.Hillenbrand@uniklinik-ulm.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hillenbrand
authors.affiliation: Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany. gigikiebler@googlemail.com.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Kiebler
authors.affiliation: Department of Pathology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany. Andreas.Hillenbrand@uniklinik-ulm.de.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schwab
authors.affiliation: Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany. l.scheja@uke.uni-hamburg.de.
authors.forename: Ludger
authors.initials: L
authors.lastname: Scheja
authors.affiliation: Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany. Pengfei.Xu@uniklinik-ulm.de.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Xu
authors.affiliation: Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany. Doris.Henne-Bruns@uniklinik-ulm.de.
authors.forename: Doris
authors.initials: D
authors.lastname: Henne-Bruns
authors.affiliation: Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany. Anna-Maria.Wolf@uniklinik-ulm.de.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Wolf
authors.affiliation: Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany. Uwe.Knippschild@uniklinik-ulm.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Knippschild
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D009929:Organ Size; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors