Physiological hepatic nuclear vacuolation-how long does it persist?

Aims: Nuclear vacuolation backslash glycogenation is a characteristic histological feature of non-alcoholic fatty liver disease (NAFLD) that can help distinguish it from alcohol-induced liver disease. There are, however, other associations of nuclear vacuolation of which the commonest is as a normal feature of childhood. The aim of this study was to identify how long this physiological nuclear vacuolation persists. Methods and results: Liver biopsy specimens from 872 patients with chronic hepatitis B virus infection (a condition known not to be associated with nuclear vacuolation) were studied to assess the frequency of nuclear vacuolation at different ages. All the patients studied had a body mass index of < 25 kg/m2 and an alcohol intake of < 15 units/week, as well as no other risk factors for liver disease. It was found that the frequency of nuclear vacuolation, in the absence of NAFLD, fell from 13% at age 20-24 years to 4% in the early 30s and to 0% at age 60-64 years. Conclusions: Physiological hepatic nuclear vacuolation is common in the 20s and persists into the 30s. This knowledge can help in the assessment of liver biopsy specimens in which nuclear vacuolation is a feature.