This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (93)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA  Topic Collections  • Diagnosis  • Gastroenterology  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

An Underrecognized Cause of Cryptogenic Cirrhosis

Jeanne M. Clark, MD, MPH; Anna Mae Diehl, MD

JAMA. 2003;289:3000-3004.

Cryptogenic cirrhosis is a common cause of liver-related morbidity and mortality in the United States. Nonalcoholic fatty liver disease (NAFLD) is now recognized as the most common cause of cryptogenic cirrhosis. However, the diagnosis of cirrhosis in patients with NAFLD appears to be delayed compared with those with other chronic liver diseases and thus carries a higher mortality rate. This delay in diagnosis is illustrated in our case of a 53-year-old man who presented with hepatic hydrothorax and ascites, whose workup revealed cirrhosis due to NAFLD. Although a diagnosis of presumed NAFLD can be made noninvasively, a definitive diagnosis requires a liver biopsy specimen. A biopsy specimen is also important for detecting histologically advanced disease, which may be clinically silent and undetected by aminotransferases or diagnostic imaging. Although there are no proven treatments, recommendations for patients with NAFLD include avoidance of hepatotoxins and aggressive management of associated conditions, such as hypertriglyceridemia and type 2 diabetes mellitus.

Author Affiliations: Departments of Medicine (Drs Clark and Diehl) and Epidemiology (Dr Clark), Johns Hopkins University, Baltimore, Md.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Diagnosis of Nonalcoholic Fatty Liver Disease
Hidekatsu Yanai and Mie Morimoto
JAMA. 2003;290(12):1577.
EXTRACT | FULL TEXT  

Diagnosis of Nonalcoholic Fatty Liver Disease
Luca Mascitelli and Francesca Pezzetta
JAMA. 2003;290(12):1577.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pathogenesis of non-alcoholic fatty liver disease
Dowman et al.
QJM 2009;0:hcp158v1-hcp158.
FULL TEXT  

Diffuse Liver Disease: Strategies for Hepatic CT and MR Imaging
Boll and Merkle
RadioGraphics 2009;29:1591-1614.
ABSTRACT | FULL TEXT  

Advanced MRI Methods for Assessment of Chronic Liver Disease
Taouli et al.
Am. J. Roentgenol. 2009;193:14-27.
ABSTRACT | FULL TEXT  

Serum Fibroblast Growth Factor 21 Is Associated with Adverse Lipid Profiles and {gamma}-Glutamyltransferase But Not Insulin Sensitivity in Chinese Subjects
Li et al.
J. Clin. Endocrinol. Metab. 2009;94:2151-2156.
ABSTRACT | FULL TEXT  

Hepatic Lipid Partitioning and Liver Damage in Nonalcoholic Fatty Liver Disease: ROLE OF STEAROYL-CoA DESATURASE
Li et al.
J. Biol. Chem. 2009;284:5637-5644.
ABSTRACT | FULL TEXT  

Obstructive Sleep Apnea, Insulin Resistance, and Steatohepatitis in Severe Obesity
Polotsky et al.
Am. J. Respir. Crit. Care Med. 2009;179:228-234.
ABSTRACT | FULL TEXT  

The Metabolic Syndrome
Cornier et al.
Endocr. Rev. 2008;29:777-822.
ABSTRACT | FULL TEXT  

Body MRI Using IDEAL
Costa et al.
Am. J. Roentgenol. 2008;190:1076-1084.
ABSTRACT | FULL TEXT  

Insulin Protects Liver Cells from Saturated Fatty Acid-Induced Apoptosis via Inhibition of c-Jun NH2 Terminal Kinase Activity
Pagliassotti et al.
Endocrinology 2007;148:3338-3345.
ABSTRACT | FULL TEXT  

Nonalcoholic Fatty Liver Disease and Insulin Resistance in Youth
Bloomgarden
Diabetes Care 2007;30:1663-1669.
ABSTRACT | FULL TEXT  

Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease: Helical CT and MR Imaging Findings with Clinical-Pathologic Comparison
Iannaccone et al.
Radiology 2007;243:422-430.
ABSTRACT | FULL TEXT  

Fatty Liver: Imaging Patterns and Pitfalls
Hamer et al.
RadioGraphics 2006;26:1637-1653.
ABSTRACT | FULL TEXT  

Saturated fatty acids induce endoplasmic reticulum stress and apoptosis independently of ceramide in liver cells
Wei et al.
Am. J. Physiol. Endocrinol. Metab. 2006;291:E275-E281.
ABSTRACT | FULL TEXT  

Saturated Fatty Acids Promote Endoplasmic Reticulum Stress and Liver Injury in Rats with Hepatic Steatosis
Wang et al.
Endocrinology 2006;147:943-951.
ABSTRACT | FULL TEXT  

Hepatic Fat Fraction: MR Imaging for Quantitative Measurement and Display--Early Experience
Hussain et al.
Radiology 2005;237:1048-1055.
ABSTRACT | FULL TEXT  

Liver Markers and Development of the Metabolic Syndrome: The Insulin Resistance Atherosclerosis Study
Hanley et al.
Diabetes 2005;54:3140-3147.
ABSTRACT | FULL TEXT  

Targeted Intestinal Overexpression of the Immediate Early Gene tis7 in Transgenic Mice Increases Triglyceride Absorption and Adiposity
Wang et al.
J. Biol. Chem. 2005;280:34764-34775.
ABSTRACT | FULL TEXT  

Effects of Diet and Genetic Background on Sterol Regulatory Element-Binding Protein-1c, Stearoyl-CoA Desaturase 1, and the Development of the Metabolic Syndrome
Biddinger et al.
Diabetes 2005;54:1314-1323.
ABSTRACT | FULL TEXT  

Beta-Cell Function in Obesity: Effects of Weight Loss
Ferrannini et al.
Diabetes 2004;53:S26-S33.
ABSTRACT | FULL TEXT  

Elevations in Markers of Liver Injury and Risk of Type 2 Diabetes: The Insulin Resistance Atherosclerosis Study
Hanley et al.
Diabetes 2004;53:2623-2632.
ABSTRACT | FULL TEXT  

Adverse Childhood Experiences, Obesity, and Liver Disease
Bachman
Arch Intern Med 2004;164:460-460.
FULL TEXT  

Diagnosis of Nonalcoholic Fatty Liver Disease
Yanai and Morimoto
JAMA 2003;290:1577-1577.
FULL TEXT  

Diagnosis of Nonalcoholic Fatty Liver Disease
Mascitelli and Pezzetta
JAMA 2003;290:1577-1577.
FULL TEXT