title: Case report of diet-related improvements of non-alcoholic steatohepatitis evaluated by four consecutive liver biopsies.
abstract: We report the case of a 46-year-old man who achieved remarkable improvement of characteristic non-alcoholic steatohepatitis by dieting. Initially, his body mass index was 40.7 kg/m2. He proactively commenced a low calorie diet and his body mass index decreased to 28 kg/m2after 4 years. During the same period, we carried out liver biopsy four times. Liver fibrosis as well as inflammation, steatosis and ballooning improved, and the non-alcoholic fatty liver disease activity score decreased from 4 to 0. The fat deposits of liver tissue changed from macrovesicular droplets to microvesicular, and finally disappeared. Along with improved histology, alanine aminotransferase, homeostasis model assessment-insulin resistance, ferritin, leptin, high-sensitivity C-reactive protein and cytokeratin 18 decreased, and adiponectin increased linearly. However, no clear changes were observed in markers for Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+M2BP), type IV collagen 7S, procollage III peptide and fibrosis-4 index along with dieting. This is the first study to report gradual improvement of liver histology during four liver biopsies and fibrosis markers in a patient with non-alcoholic steatohepatitis who achieved complete recovery solely by dieting.
authors.affiliation: Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City, Japan.
authors.forename: Miwa
authors.initials: M
authors.lastname: Kawanaka
authors.affiliation: Department of Gastroenterology, Okayama City Hospital, Okayama City, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nouso
authors.affiliation: Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City, Japan.
authors.forename: Syoichiro
authors.initials: S
authors.lastname: Yano
authors.affiliation: Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakamura
authors.affiliation: Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nishino
authors.affiliation: Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Suehiro
authors.affiliation: Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
keywords: biopsy; diet; histology; liver; non-alcoholic fatty liver disease; non-alcoholic steatohepatitis