We characterized 70 consecutive patients with cryptogenic
cirrhosis to assess major risks for liver disease. Each
patient was reevaluated for past alcohol exposure, scored by
the International Autoimmune Hepatitis (IAH) score and
assessed for viral hepatitis risks and risks for nonalcoholic
steatohepatitis (NASH). The results were compared with 50
consecutive NASH patients, 39 nonalcoholic patients age 50
and over with cirrhosis from hepatitis C, and 33 consecutive
patients with cirrhosis caused by primary biliary
cirrhosis (PBC). Among the cryptogenic group, 49 (70%)
were female, and the mean age was 63 6 11 years. Although
ascites and variceal bleeding were common, almost one half
lacked major signs of complicated portal hypertension. A
history of Type 2 diabetes mellitus and/or obesity was
present in 51 (73%). Nineteen (27%) patients had a history
of blood transfusions antedating the diagnosis of cirrhosis.
No clinical or histological features distinguished this group
from the other patients, and 14 (74%) of these had a history
of obesity and/or diabetes. Nineteen of the remaining
nontransfused patients had indeterminant IAH scores but
were histologically and biochemically indistinguishable
from the others. Twelve of these (63%) also had a history of
obesity and/or diabetes. Both diabetes and obesity were
significantly more common in the cryptogenic cirrhotic
patients compared with the cirrhotic patients with PBC or
hepatitis C. In contrast, the prevalence of obesity and
diabetes was similar to the NASH patients who were, on
average, a decade younger. Although there is some diversity
that indicates more than one cause, our findings suggest
that NASH plays an under-recognized role in many patients
with cryptogenic cirrhosis, most of whom are older, type 2
diabetic and obese females. (HEPATOLOGY 1999;29:664-669.)