All patients enrolled in this study underwent percutaneous liver biopsy under ultrasonic guidance. The liver specimens were embedded in paraffin and stained with hematoxylin and eosin, and Masson's trichrome. The minimum biopsy size was 20 mm and the number of portal areas was 10. The liver biopsy specimens were reviewed by two hepatopathologists (T.O. and Y.S.) who were blinded to the clinical data. Fatty liver was defined as the presence of steatosis in at least 5% hepatocytes, while steatohepatitis was diagnosed by steatosis, inflammation, and hepatocyte ballooning [2 (link),3 (link),26 (link)]. The individual parameters of NASH histology, including fibrosis, were scored independently using the NASH Clinical Research Network (CRN) scoring system developed by the NASH CRN [26 (link)]. Advanced fibrosis was classified as stage 3 or 4 disease (bridging fibrosis or cirrhosis).
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