Tiribelli C

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Non alcoholic steatohepatitis (NASH) with diabetes: Predictors of liver fibrosis, by DN Amarapurkar et al

Hepatic steatosis (plus or minus fibrosis and inappropriate ethanol intake) is becoming “the problem” in several liver centers around the world. Several reports now conclude that obesity and diabetes are two of the main risk factors for the disorders. These risks together with high blood pressure, increased insulin resistance and hyperlipoproteinemiaare making liver steatosis a landmark for the so call “metabolic syndrome”. However still more that tenuous is the border between simple fatty liver and NASH. The distinction is not only taxonomic and academic since the prognosis of the two clinical entities is quite different. The golden standard is liver biopsy which, unfortunately is invasive and may have some, though very limited, risk. Several surrogates have been suggested (fibrotest, fibroscan, others) but all of them still need a definite validation in larger series worldwide. Amarapurkar et al tried to answer the issue by analyzing the possible correlation between the degree of liver fibrosis (assessed by biopsy) and several clinical and biochemical variables.