These criteria were chosen because sustained virological response to anti-HCV therapy improves the outcomes of these patients. The study was approved by appropriate regulatory bodies at all centers, and written informed consent was obtained from all patients for participation in medical research. NAFLD was diagnosed based on the following: (1) elevated aminotransferases for at least 6 months; (2)

click here liver biopsy showing changes consistent with advanced fibrotic NAFLD (detailed below); and (3) exclusion of other etiologies, including viral, autoimmune, cholestatic, genetic, metabolic, alcoholic, or drug-induced liver diseases. These other etiologies were excluded using specific biochemical, clinical, radiological, and/or histological criteria.

All patients had current and past consumption of ethanol less than 20 g per day on direct questioning of both the patients and a close relative. A complete medical history and physical examination was undertaken. Body mass index (BMI) was calculated using the following formula: weight (in kilograms)/height2 (in meters). Waist circumference (to the nearest half centimeter) was measured at the midpoint between the lower border of the ribcage and the iliac crest. Serum measurements included routine liver biochemistry (alanine aminotransferase [ALT] and aspartate aminotransferase [AST] levels, total bilirubin, albumin, alkaline phosphatase, and gamma glutamyl transpeptidase), complete blood count, fasting glucose, fasting insulin, total cholesterol, high-density lipoprotein (HDL) cholesterol, and total trigycerides, MCE serology Fostamatinib ic50 for hepatitis B and C viruses, iron studies, autoantibodies, alpha 1 antitrypsin levels and phenotype, and ceruloplasmin levels. Components of the metabolic syndrome, including central obesity, hyperglycemia,

hypertrigylceridemia, hypertension, and low HDL cholesterol, were recorded. Liver biopsies were stained with hematoxylin and eosin, Masson’s trichrome, and special stains for iron and copper. Liver biopsies were read by a single liver pathologist in each participating center. Histological features of NAFLD, such as steatosis, inflammation, hepatocyte ballooning, and fibrosis, were scored as previously described.14, 15 Only those patients that had steatosis of at least 5% plus severe fibrosis (stage 3 [septal/bridging]) or cirrhosis (stage 4) fibrosis were included in this analysis. Other histological changes of steatohepatitis, such as inflammation and ballooning, were not required as inclusion criteria. For HCV, the degree of fibrosis was scored according to the METAVIR scale16 as follows: stage 0, no fibrosis; stage 1, enlarged portal tract without septa; stage 2, enlarged portal tract with rare septa; stage 3, numerous septa without cirrhosis; stage 4, cirrhosis. Only those patients with fibrosis stage 3 or 4 disease were included.