Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2018; 10(1): 34-40
Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.34
Risk factors for hepatic steatosis in adults with cystic fibrosis: Similarities to non-alcoholic fatty liver disease
Fares Ayoub, Cesar Trillo-Alvarez, Giuseppe Morelli, Jorge Lascano
Fares Ayoub, Department of Medicine, University of Florida, Gainesville, FL 32608, United States
Cesar Trillo-Alvarez, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL 32608, United States
Giuseppe Morelli, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32608, United States
Jorge Lascano, Department of Medicine, Adult Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL 32608, United States
Author contributions: Ayoub F and Morelli G collected the data; Ayoub F analyzed the data; Ayoub F, Morelli G, Lascano J and Trillo-Alvarez C wrote the paper; Trillo-Alvarez C, Morelli G and Lascano J reviewed the paper.
Institutional review board statement: This study was reviewed and approved by the University of Florida Institutional Review Board (IRB201500737).
Informed consent statement: This was a retrospective review, the institutional review board provided a waiver of informed consent since no identifiable patient information would be collected or shared.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this work.
Data sharing statement: Technical appendix, statistical code and datasets are available from the corresponding author at No additional data are available other than what is included in the article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Fares Ayoub, MD, Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32608, United States.
Telephone: +1-352-2650239
Received: October 21, 2017
Peer-review started: October 24, 2017
First decision: November 23, 2017
Revised: December 6, 2017
Accepted: December 13, 2017
Article in press: December 13, 2017
Published online: January 27, 2018

To investigate the clinical, biochemical and imaging characteristics of adult cystic fibrosis (CF) patients with hepatic steatosis as compared to normal CF controls.


We performed a retrospective review of adult CF patients in an academic outpatient setting during 2016. Baseline characteristics, genetic mutation analysis as well as laboratory values were collected. Abdominal imaging (ultrasound, computed tomography, magnetic resonance) was used to determine presence of hepatic steatosis. We compare patients with hepatic steatosis to normal controls.


Data was collected on 114 patients meeting inclusion criteria. Seventeen patients (14.9%) were found to have hepatic steatosis on imaging. Being overweight (BMI > 25) (P = 0.019) and having a higher ppFEV1 (75 vs 53, P = 0.037) were significantly associated with hepatic steatosis. Patients with hepatic steatosis had a significantly higher median alanine aminotransferase level (27 vs 19, P = 0.048). None of the hepatic steatosis patients had frank CF liver disease, cirrhosis or portal hypertension. We found no significant association with pancreatic insufficiency or CF related diabetes.


Hepatic steatosis appears to be a clinically and phenotypically distinct entity from CF liver disease. The lack of association with malnourishment and the significant association with higher BMI and higher ppFEV1 demonstrate similarities with non-alcoholic fatty liver disease. Long term prospective studies are needed to ascertain whether CF hepatic steatosis progresses to fibrosis and cirrhosis.

Keywords: Cystic fibrosis liver disease, Hepatic steatosis, Non-alcoholic fatty liver disease

Core tip: Our retrospective cohort study of cystic fibrosis (CF) patients with hepatic steatosis demonstrates that hepatic steatosis in CF is associated with a higher body mass index as well as a higher percent predicted forced expiratory volume in 1 s, as compared to normal CF controls. None of our patients with hepatic steatosis exhibited evidence for advanced liver disease. Our findings are novel and demonstrate similarities between hepatic steatosis in CF and adult non-alcoholic fatty liver disease and future prospective studies are required to determine whether this steatosis may evolve into cirrhosis.