Valproic acid and nonalcoholic fatty liver disease: A possible association?

Table 1 Nonalcoholic steato-hepatitis Clinical Research Network Scoring System (adapted from ref. [3])

Item	Definition		Score/code
Steatosis
	Grade	Low-to medium-power evaluation of parenchymal involvement by steatosis
		< 5%	0
		5%-33%	1
		> 33%-66%	2
		> 66%	3
	Location	Predominant distribution pattern
		Zone 3	0
		Zone 1	1
		Azonal	2
		Panacinar	3
	Microvesicular steatosis	Contiguous patches
		Not present	0
		Present	1
Fibrosis
	Stage	None	0
		Perisinusoidal or periportal	1
		Mild, zone 3, perisinusoidal	1A
		Moderate, zone 3, perisinusoidal	1B
		Portal/periportal	1C
		Perisinusoidal and portal/periportal	2
		Bridging fibrosis	3
		Cirrhosis	4
Inflammation
	Lobular inflammation	Overall assessment of all inflammatory foci
		No foci	0
		< 2 foci per 200 × field	1
		2-4 foci per 200 × field	2
		> 4 foci per 200 × field	3
	Microgranulomas	Small aggregates of macrophages
		Absent	0
		Present	1
	Large lipogranulomas	Usually in portal areas or adjacent to central veins
		Absent	0
		Present	1
	Portal inflammation	Assessed from low magnification
		None to minimal	0
		Greater than minimal	1
Liver cell injury
	Ballooning	None	0
		Few balloon cells	1
		Many cells/prominent ballooning	2
	Acidophil bodies	None to rare	0
		Many	1
	Pigmented macrophages	None to rare	0
		Many	1
	Megamitochondria	None to rare	0
		Many	1
Other findings
	Mallory's hyaline	Visible on routine stains
		None to rare	0
		Many	1
	Glycogenated nuclei	Contiguous patches
		None to rare	0
		Many	1