Fatty liver: Experience from western India

Introduction: Incidence of fatty liver is rising all over the world. Non alcoholic Steatohepatitis which is a subset of fatty liver disease has become a major concern since it is known to progress to liver cirrhosis. Obesity and diabetes mellitus are considered to be the important risk factors for nonalcoholic steatohepatitis. However fatty liver is also seen in non obese and non diabetic individuals. The epidemiology of fatty liver disease slightly differs in different countries, specially,where various infections are more prevalent. Aim: To determine various risk factors responsible for steatosis and to assess severity of steatosis with fibrosis amongst various groups. Material and methods: Total 1,230 adult autopsies were screened over the period of 4 years. Amongst them 195 cases showing fatty liver were included in the study. Different risk factors responsible for fatty liver were analyzed from the clinical data and laboratory findings obtained from hospital records. Liver histological sections were studied for the presence of steatosis, inflammation and fibrosis. These 3 histological parameters were compared amongst the risk factors. Results: Alcoholism was found to be the commonest risk factor for staetosis followed by tuberculosis. Other risk factors were cardiac disorders, diabetes, hypertension, Hepatitis B & C infection, HIV and miscellaneous conditions. Overall prevalence of steatosis was found to be 15.8%. Steatosis, inflammation and fibrosis were more common in alcoholics. Tuberculosis was the second commonest risk factor, showed grade 2 to 3 steatosis however inflammation and fibrosis were significantly less in cases of tuberculosis. Findings in other risk factors were variable. Conclusion: Overall prevalence of fatty liver in this autopsy study was found to be 15.8%. Alcoholism was the commonest risk factor followed by tuberculosis. Fibrosis was mainly observed in association with alcoholism as compared to other risk factors.