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.
- Diabetes Mellitus
- Liver Diseases
Data availability statement
Data are available upon reasonable request.
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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.
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