About one-third of patients did not meet NCEP criteria for the metabolic syndrome.13 NAFLD may be a sensitive early indicator of insulin resistance; whether the presence of NAFLD predicts the future development of the metabolic syndrome will require continued observation of these patients. Additional useful observations for clinicians from this large cohort include the prevalence of acanthosis nigricans and autoantibodies. Acanthosis nigricans, previously thought to be rare in NASH, is a cutaneous manifestation of insulin resistance and

was found in 12% of patients with NAFLD. Recognizing this regional hyperpigmentation, typically occurring in adults around the neck and over knuckles, elbows, and knees provides clinicians with a physical Selleckchem Dabrafenib clue to the presence of insulin resistance and affords the opportunity to educate patients on the

underlying cause of this often unexplained skin change. The detection of autoantibodies during evaluation of patients with suspected liver disease can raise questions about unrecognized primary biliary cirrhosis or autoimmune hepatitis. This study identified a positive RO4929097 AMA without histologic evidence of primary biliary cirrhosis in 4% of patients, similar to that in a smaller study.23 One-third of patients had either a positive ANA or ASMA and 5% had both positive without histological evidence of autoimmune hepatitis. These observations confirm findings in smaller studies.24-26 Several clinical

and biochemical parameters were associated with an increased likelihood of having NASH, but these differences were not quantitatively large (Table 2). It is worth noting that 16% of biopsies did not meet NASH criteria yet had a NAS ≥ 5, emphasizing the point, previously made, that the NAS is not a substitute for a diagnosis of NASH.12 Larger biopsies are more likely to include findings that support a diagnosis of NASH,21, 22 and consistent with this observation was the finding that the absence of definite NASH was more likely when the total biopsy core length was < 10 mm. Identifying early fibrosis may identify patients at risk for progressing to cirrhosis over time. As shown in Table 3, there were a 上海皓元医药股份有限公司 large number of differences in clinical and laboratory parameters associated with the progressive stages of fibrosis, but these differences were generally not quantitatively large. Notable exceptions included the higher prevalence of diabetes and more advanced age with advanced fibrosis, the increase in AST/ALT ratio as fibrosis progresses, and the relative thrombocytopenia known to occur with cirrhosis. These variables have consistently emerged in several studies as predictive of the presence of advanced fibrosis.