Obesity

Question: Obesity is known to affect which of the following liver conditions?

A. hepatitis C

B. NASH

C. cirrhosis

D. all of the above

 

Answer: Although obesity is nearly synonymous with NASH in the world of hepatology, you must recognize that obesity affects other liver-related conditions as well.  For example, obesity increases the rate of progression of fibrosis in HCV.  Furthermore, obesity decreases the sensitivity to antiviral treatment for HCV.

It has also been shown that obesity is an independent risk factor for clinical decompensation in patients with cirrhosis.  That’s right, in a multivariate analysis, BMI along with serum albumin and HVPG increased risk of clinical decompensation (ascites, encephalopathy or variceal hemorrhage).

Of course, NASH is intimately related to obesity.  Increased import of fatty acids (from adipose tissue) to the liver overwhelms the liver’s capacity to oxidize them, which results in steatosis.  Various adipokines, seen in higher levels in obesity, trigger an inflammatory response within the liver, and promote steatohepatitis.  So, in sum, all of the above answers are correct.

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