Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis:A case-control study

It has recently been suggested that nonalcoholic steato-hepatitis (NASH) is an under-recognized cause of cryptogenic cirrhosis (CC) on the basis of hi gher prevalence of obesity and type II diabetes among these patients. To te st this hypothesis, we studied 65 consecutive patients with advanced cirrho sis (Child-Pugh Score greater than or equal to 7) of undetermined etiology (CC) from our active waiting list for liver transplantation in January 1993 , 1996, and 1999. For each patient, we selected 2 age- and sex-matched cont rols from the corresponding lists. The prevalence of obesity (defined as bo dy mass index [BMI] greater than or equal to 30) and diabetes were compared between the groups. Sixteen patients land their 32 controls) with CC were excluded as further review of records suggested other possible etiologies. Thus, the final analysis included 49 patients and 98 controls. The etiology of cirrhosis in the control group was alcohol in 16.3%, chronic viral hepa titis in 30.6%, autoimmune hepatitis in 8.2%, and primary biliary cirrhosis (PBC) or primary sclerosing cholangitis in 35.7%. The prevalence of obesit y (55% vs. 24%) and type II diabetes (47% vs. 22%) was significantly higher in patients with CC compared with controls. Twenty-three percent of patien ts with CC had both obesity and diabetes compared with 5% among controls (P =.002), There was no difference in the prevalence of hypercholesterolemia (serum cholesterol > 200 mg/dL) between the groups, In conclusion, patients with advanced CC are more likely to be obese and diabetic compared with ag e- and sex-matched patients with advanced cirrhosis, This supports the hypo thesis that NASH may be an etiological factor in some of the patients with CC.