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World J Gastroenterol. Apr 7, 2006; 12(13): 2080-2085
Published online Apr 7, 2006. doi: 10.3748/wjg.v12.i13.2080
Cryptogenic cirrhosis in the region where obesity is not prevalent
Hideyuki Kojima, Shinya Sakurai, Masahiko Matsumura, Norie Umemoto, Masahito Uemura, Hiroyo Morimoto, Yasuhiro Tamagawa, Hiroshi Fukui
Hideyuki Kojima, Shinya Sakurai, Norie Umemoto, Masahito Uemura, Hiroshi Fukui, Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8522, Japan
Masahiko Matsumura, Department of General Medicine and Clinical Investigation, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8522, Japan
Hiroyo Morimoto, Yasuhiro Tamagawa, Department of Internal Medicine, Kokuho Central Hospital, 404-1 Miyako Tawaramoto-cho, Nara 636-0302, Japan
Author contributions: All authors contributed equally to the work.
Supported by Grant-in-Aid for Scientific Research, No. 17590669
Correspondence to: Hideyuki Kojima, Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara 634-8522, Japan. kojima@nmu-gw.naramed-u.ac.jp
Telephone: +81-744-223051
Received: August 22, 2005
Revised: September 25, 2005
Accepted: October 26, 2005
Published online: April 7, 2006
Abstract

AIM: Recent studies have demonstrated that obesity is the common feature of cryptogenic cirrhosis (CC) and non-alcoholic steatohepatitis. However, there is little information on CC in the region where obesity is not prevalent.

METHODS: The clinical features, and the liver-related morbidity and mortality of CC were analyzed in Japan where the prevalence of obesity is low. Among 652 cirrhotic patients, we identified 29 patients (4.4%) with CC. Of these, 24 CC patients who were followed up for more than 6 months were compared in a case-control study with age-, sex-, and Child-Pugh score-matched controls having cirrhosis of viral etiology.

RESULTS: Obesity (BMI≥25 kg/m2), diabetes mellitus, and hypertriglyceridemia were more frequent, and the visceral fat area was larger in the CC patients than in the controls. The indices of insulin resistance were higher and the serum aminotransferase levels were lower in the CC patients than in the controls. Logistic regression analysis identified the elevated hemoglobin A1c, BMI ≥ 25 kg/m2, and normal aminotransferase levels as independent predictors of CC. Kaplan-Meier analysis demonstrated lower occurrence of hepatocellular carcinoma and higher survival rate in the CC than in the controls in contrast to the similar cumulative probability of liver-related morbidity between those groups.

CONCLUSION: CC more frequently presents with the clinical features suggestive of non-alcoholic steatohepatitis compared with controls even in the region where obesity is not prevalent. The lower occurrence of hepatocellular carcinoma and higher survival rate may indicate an indolent clinical course in CC as compared with viral cirrhosis.

Keywords: Cryptogenic cirrhosis; Viral cirrhosis; Non-alcoholic steatohepatitis; Hepatocellular carcinoma; Case-control study