Article Text

Download PDFPDF
Postmortem survey of haemoglobin A1c, non-alcoholic steatohepatitis and liver fibrosis within a general population
  1. Kristina-Ana Klaric1,
  2. Jacqueline Louise Parai1,2,
  3. Charis Anthea Kepron1,2,
  4. Alfredo Eugene Walker1,2,
  5. Christopher Mark Milroy1,2
  1. 1 Department of Pathology and Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
  2. 2 Pathology and Laboratory Medicine, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
  1. Correspondence to Dr Christopher Mark Milroy, Department of Pathology and Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, ON K1N 6N5, Canada; cmilroy{at}


Aims Non-alcoholic steatohepatitis (NASH), fatty liver disease and fibrosis are associated with diabetes mellitus and obesity. Previous autopsy series have reported prevalence of fatty liver disease to be 11%–24%. Recent studies, using imaging and serology, suggest a prevalence of 20%–35%, NASH of 5% and advanced fibrosis of 2%–3%. We examined the prevalence of NASH and liver fibrosis in a general autopsy population.

Methods A cross-sectional study of consecutive, adult, medicolegal autopsies over a 1-year period was conducted. Liver sections were scored for fibrosis, inflammation and steatosis using a modified NASH scoring system. Stepwise logistic regression was used to identify associations between NASH or moderate/severe fibrosis and several clinicopathological parameters, including postmortem haemoglobin A1c (HbA1c).

Results Of 376 cases, 86 (22.9%) were classified as NASH. Prevalence of diabetes mellitus, body mass index (BMI) and postmortem HbA1c were significantly higher in NASH cases (39.5%, 32.3 kg/m2 and 6.88%) than non-NASH cases (12.1%, 27.0 kg/m2 and 5.73%). Decedents with moderate/severe fibrosis (6.9%) had higher prevalence of diabetes, BMI and HbA1c (50%, 31.4 kg/m2 and 6.7%) compared with those with no/mild fibrosis (16%, 28 kg/m2 and 5.9%). HbA1c ≥7% was found to be an independent predictor of NASH (OR 5.11, 95% CI 2.61 to 9.98) and advanced fibrosis (OR 3.94, 95% CI 1.63 to 9.53).

Conclusions NASH and advanced fibrosis were higher in our general adult autopsy population compared with previously published estimates. This is a large series with histological evaluation showing that HbA1c >7.0% is independently associated with NASH and advanced fibrosis.

  • Autopsy
  • Diabetes Mellitus
  • fibrosis
  • Liver Diseases

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Handling editor Tahir S Pillay.

  • Contributors K-AK wrote the manuscript, evaluated and scored the liver histology and analysed the data. JLP collected demographic and autopsy information, analysed the data and performed statistical analysis. CAK and AEW collected demographic and autopsy information. CMM collected demographic information, and evaluated and scored the liver histology. JLP and CMM conceived the idea for the study and the study design, provided guidance and critically revised the manuscript. All authors read and approved the final paper. CMM is the guarantor of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.