The Presence of White Matter Lesions Is Associated With the Fibrosis Severity of Nonalcoholic Fatty Liver Disease.
We tested whether nonalcoholic fatty liver disease (NAFLD) and/or its histological severity are associated with vascular white matter lesions (WML) in patients with biopsy-proven NAFLD and in non-NAFLD controls. Data were recorded in 79 consecutive biopsy-proven NAFLD, and in 82 controls with normal ALT and no history of chronic liver diseases, without ultrasonographic evidence of steatosis and liver stiffness value <6 KPa. All subjects underwent magnetic resonance assessment and WML were classified according to the Fazekas score as absent (0/III), or present (mild I/III; moderate II/III, and severe I/III). For the purpose of analyses, all controls were considered without NASH and without F2-F4 liver fibrosis. WML were found in 26.7% of the entire cohort (43/161), of moderate-severe grade in only 6 cases. The prevalence was similar in NAFLD versus no-NAFLD (29.1% vs 24.3%; P = 0.49), but higher in NASH vs no-NASH (37.7% vs 21.2%, P = 0.02) and F2-F4 vs F0-F1 fibrosis (47.3% vs 20.3%, P = 0.001). In both the entire cohort and in NAFLD, only female gender (OR 4.37, 95% CI: 1.79-10.6, P = 0.001; and OR 5.21, 95% CI: 1.39-19.6, P = 0.01), age > 45 years (OR 3.09, 95% CI: 1.06-9.06, P = 0.03; and OR 11.1, 95% CI: 1.14-108.7, P = 0.03), and F2-F4 fibrosis (OR 3.36, 95% CI: 1.29-8.73, P = 0.01; and OR 5.34, 95% CI: 1.40-20.3, P = 0.01) were independently associated with WML (mostly of mild grade) by multivariate analysis. Among NAFLD, the prevalence of WML progressively increased from patients without (1/18; 5.5%), or with 1 (1/17, 5.8%), to those with 2 (9/30; 30%) and further to those with 3 (12/14; 85.7%) risk factors. The presence of WML is not associated with NAFLD, but with metabolic diseases in general, and fibrosis severity of NAFLD. Clinical implications of this issue need to be assessed by longitudinal studies.
From the Sezione di Gastroenterologia e Epatologia (SP, CC, VDM, AL, AC), Sezione di Medicina Interna, DiBiMIS, University of Palermo (AT, CM, GP, DT, AP), Sezione di Scienze Radiologiche, Dipartimento di Biopatologia e Biotecnologie Mediche (DI.BI.MED.), Universita[Combining Grave Accent] degli Studi di Palermo (CG, GB, GLT, MM), Medicina Generale Palermo (RZ, LG, FM, GM), Cattedra di Anatomia Patologica, University of Palermo, Palermo (DC), and Dipartimento di Scienze Mediche e Chirurgiche, "Alma Mater Studiorum," Università di Bologna, Bologna, Italy (GM).
Salvatore
S
Petta
Antonino
A
Tuttolomondo
Cesare
C
Gagliardo
Rita
R
Zafonte
Giuseppe
G
Brancatelli
Daniela
D
Cabibi
Calogero
C
Cammà
Vito
V
Di Marco
Luigi
L
Galvano
Giuseppe
G
La Tona
Anna
A
Licata
Franco
F
Magliozzo
Carlo
C
Maida
Giulio
G
Marchesini
Giovanni
G
Merlino
Massimo
M
Midiri
Gaspare
G
Parrinello
Daniele
D
Torres
Antonio
A
Pinto
Antonio
A
Craxì
D001706:Biopsy; D001927:Brain Diseases / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000175:diagnosis; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography; D066127:White Matter / Q000473:pathology