Introduction: Minimal hepatic encephalopathy (MHE) is defined as asymptomatic abnormal cognitive functions found in patients with advanced chronic liver disease. Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition, linked to diabetes, hypertension, and obesity. Significant steatosis can be associated with manifestations of portal hypertension at the early fibrosis stages. We aimed to describe the prevalence of MHE in patients with NAFLD across all fibrosis levels and look for possible predictors.
Methods: Forty-eight consecutive patients followed for NAFLD in the liver unite and obesity clinic were interviewed, examined, and underwent abdominal ultrasonography(US), laboratory testing and MHE evaluation. Liver fibrosis was assessed using transient elastography (TE). MHE testing included number connection (NCT), digit symbol (DST) tests, computerized Stroop and inhibitory control tests (ICT).
Results: Out of 48 patients 43 had fatty liver on US and were eligible for further evaluation. Average time from fatty liver diagnosis was 7.3 ±5.8 years. Thirty (68%) of the patients had metabolic syndrome, 19 (44%) and 28 (65%) had diabetes and hypertension respectively. Seventeen (40%) patients had advanced fibrosis (11 patients with F3 and 6 patients with F4), no patients with decompensated cirrhosis were included. High prevalence of constitutional symptoms was observed in NAFLD patients: weakness and fatigue in 26 (60%) and 10 (23%) respectively, decreased concentration ability in 13 (30%) and sleep disturbance in 10(23%) patients. Using specialized tests, MHE was diagnosed in only 3 (7%) patients (two with advanced fibrosis level). There was no association between metabolic parameters or ammonia levels with MHE.
Conclusions: Despite high prevalence of neurological complains in NAFLD patients, only small proportion of them has true MHE. Upon conclusion of recruitment we anticipate to find potential predictors of MHE in this population and address the possible impact of steatosis and fibrosis on development of complications of portal hypertension
