Challenges in the hepatic histopathology in non-alcoholic fatty liver disease

Bedossa et al1 present a cross-sectional clinicopathological correlation study of 798 consecutively prospectively obtained liver biopsies from patients who underwent bariatric surgery for severe obesity (body mass index >40 or >35 kg/m² in whom at least one obesity-related comorbidity existed). Clinical phenotyping included body weight and composition by dual-emission X-ray absorptiometry (DXA), relative and total body fat mass, limb fat measurements and fasting venous samples for liver, glucose and insulin tests. Diabetes and metabolic syndrome were defined according to international criteria, and 84% of subjects also had abdominal subcutaneous fat needle aspiration biopsies. The latter were analysed for adipocyte size and volume by published methods.2

As expected, the majority of subjects were women (78%), and Caucasian (73.5%). A range of liver histology was found, including 141 (18%) with 'no' (grade 0) steatosis (0%–5%) and no other lesions, and 38 (5%) with grade 0 steatosis, but with...

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