Background:  Although steatosis is common in patients with severe hyperhomocysteinemia due to deficiency of cystathionine β‐synthase, there are no satisfactory data on homocysteine concentrations in patients with non‐alcoholic fatty liver disease. The main aim of the present study was to evaluate the clinical significance of plasma homocysteine concentrations in patients with non‐alcoholic fatty liver disease.

Methods:  Seventy‐one non‐alcoholic fatty liver disease patients, 36 patients with chronic viral hepatitis and 30 healthy persons were enrolled in the study. Homocysteine levels were measured by high‐performance liquid chromatography. Insulin, folate, vitamin B₁₂ and lipoprotein levels were also determined in all groups.

Results:  Homocysteine in the non‐alcoholic fatty liver disease group was found to be significantly higher than other groups. Homocysteine was found to be significantly higher in the non‐alcoholic steatohepatitis group when compared with simple steatosis group. A positive correlation was found between homocysteine and triglyceride, very‐low‐density‐lipoprotein (VLDL) cholesterol, insulin, and index of insulin resistance in the non‐alcoholic fatty liver disease group, and a negative correlation was found between homocysteine and folate, or vitamin B₁₂ in all groups. The homocysteine threshold for the prediction of steatohepatitis was 11.935 ng/mL. Furthermore; plasma homocysteine was a statistically significant predictor for severity of necroinflammatory activity in non‐alcoholic steatohepatitis.

Conclusions:  The plasma homocysteine concentrations were significiantly higher in patients with non‐alcoholic fatty liver disease, while the concentrations were not affected by chronic viral hepatitis. Plasma homocysteine is a parameter for discriminating steatohepatitis from simple steatosis. Determining the plasma homocysteine concentrations may facilitate selection of steatosis patients in whom a liver biopsy should be performed.

© 2005 Blackwell Publishing Asia Pty Ltd