patients with NASH, those with DM when compared to those without DM had 35 genes that were significantly up-regulated by more than 2dbld (collagen type XVI1, alpha 1, glutathione peroxidase 2, mannose receptor and mannose-binding lectin). Finally', NAFL patients with significant 1R (HOMA>2.2) had significant do,am-regulation of insulin-like growth factor binding protein-1 as compared to those without 1R. Conclusions: In patients with NAFL, signitkant ditterences in both gene expression and biochemical markers exist between DM and non~DM. Moreover, we find interesting genomic and biochemical differ- ences in NAFL patmuts with 1R across the spectrum of NAFL. M1402 Insulin Resistance, Serum Leptin and Fibrosis in Non-Alcoholic Fatty" Liver Disease (NAFL) Timothy" Born, Janus P, Ong, Karen Schlauch, Hazem Elariny, Abraham Younoszai, Zachary Goodman, Nan Christensen Jennifer Assmann, Vikas Chandhoke, Zobair M Younossi Insulin*resistance (IR) appears to contribute to the pathogenesis of NAFL Aim: Potential associations of 1R, serum leptin and cytokmes with the progressive form of NAFL. Methods: Our NAFL database was used to identify patients with biopsy-proven NAFi. for whom fi'ozen serum samples from the time of biopsy were available. All other forms of liver disease were excluded and a single pathologist had reviesved all slides classifying them into steatosis alone, steatosis ,,,nt h non-specific inflammation and NASH (presence of steatosis swth pericd- Mar fibrosis or steatosis w~th hepatocyte ballooning plus Mallory bodies). For each patient, extensive clmical data was available Fasting serum was used tbr the determination of insulin, glucose, leptm, TGF-beta, TNF~alpha and hyaluronic acid QUICRI and HOMA were' calculated according to previously described methods (e.g Dessein, 2002). Univariate and multivariate analyses wet~ performed to determine assc<'iations of these markers with histologic diagnosis of NASH as well as presence of histologlc fibrosis Results: 0[ 97 patients `a'lth available so'urn, 13% had steatosis alone, 55% had steatosis with non-specific inflammation and 32% had NASH. Of these, 18% were male, age 394_+98, BM1482• kg/'m ~ and 16% had type 2 diabetes (DM). In comparison to NASH, patients swth steatosis alone had lower lasting serum insulin 5 87 _+ 466 vs. 12 06 • 7 17 g,U/ml (p = 0,008) and less evidence for IR (HO~,s 1.61+_183 vs. 367-+2.51, p=0,01, QUICKI: 0.38-+0.05 vs 0.33 • 004, p<0,001) Furtbermore, NAFL patients with the established DM had definite evidence for iR (HOMA 6 15 -+ 927 s~ 305 _+2 53, p = 0.012). There is a significant differ- ence (p=0.006) in the three subtypes of NAFL and insulin resistance defined by HOMA > 2,2: patients with histologic NASH had a higher percentage of insulin resistance than those with steatosis alone, and those with steatosis and non-specific inflammation. In NASH, there was a moderate but sigm ficant correlation between HOM4 and BMI(r = 0.47, p<0,002), as well as between fasting serum insulin and BMI (r=0.55 p<0.001). Serum leptin, hyalurunic acid and TGF-beta did not differ across the spectrum of NAFL and were not associated `aqth the histologic stage of hbrosis Conclusions: In this cohort of patients svtth NAFL, markers ot IR were associated with the potentially progressive form of NAFL or NASH M1403 Relationship Between Nonalcoholic Steatohepatitis and Heterozygosity for the LCHAD (G1528C) Mutation Annie T Chemmanur, Zi Yang Yiwen Zhao, John Gilliam, Kristina T. IvlcNeal, Richard W. Lambrecht, Wdliam Outlaw, Herbert L. Bonkovsky, Jamai A. lbdah Introduction: Nonalcohdie steatohepatitis (NASH) is a necro-intlammatory disorder of the liver associated with tarry infiltration of hepatocytes, Its etiology remains unknown, but it is being recognized with increasing frequency. The evidence suggests that some individuals are genetically susceptible [or the development of NASH, Fatty acid oxidation defects are a recently characterized, recessively inherited group of genetic disorders with a histologlc hallmark of hepatic steatos*s, Long chain 3&ydmxy,acybCoA dehydrogenase (LCHAD) defi- ciency is one of tbese disorders with a reported common mutation (G1528C) in 60% of the nmtant alleles. It is estimated that approximately 1/175 of the general population is beteruzygous tbr this mutation A strong association between this mutation and development of acute fatty liver of pregnancy has been reported (Ibdah et al, N EngL J, Med. 340:1723- 1731, 1999), The role of hetemzygnsity l~r the LCIKt~D mutation in the development of NASH is now coming under study, Hypothesis: Heterozygnsity for the LCHAD mutation may pre-dispose to the development of NASH, Methods: 74 patients with a final diagnosis ot NASH seen at UMASS Liver Center and Wake Forest Umversity Baptist Medical Center were studied. DNA isolated from these patients was screened for the common LClKAD mutation using single strand confbrmatlon variance (SSCV) and/or restriction fragment length polynrorphism (RFLP) analyses. Results: Three subjects out of 74 (4.05%) were heterozygous for the common LCHAD mutation vs. 0.56% in normal controls, with a resultirg p-value of 0,039, Conclusion: This initial result suggests that there may be an increased prevalence of the LCtLAD mutation in NASH patients Furthar study of this gene in a larger sample of NASH patients is in progress, M1404 Impact of Insulin Resistance on Levels of Aminotransferases and ~/- glutamyltranspeptidase in a General Population Masakatsu Uchihara, Namiki Izumi Mayumi Shimizu, Osamu Nognchi, Yasuhiro Asahina, Jun ltakura, Kaoru Tsuchiya, Kohsei Hamano, Yuki Nishimura, Ken Ueda, Kazunari Inoue tGtom Kanno, Shozo Miyake in a general population both alcoholic liver disease and nonalcoholic tarry liver disease (NAFLD) are main cause of liver injury'. Howevm', distinction between NAFLD and alcoholic fiver disease may not always be easy, especially in those with modest alcohol consumption Since obesity and diabetes have been reported to be important risk |a.ctors tbr the development ot akoholic liver disease, insulin resistance seems to play an imLportant role in liver dysfunction in occasional or habitual drinkers as have been observed in NAFLD. To confirm this hypothesis, relationships among alanine aminotr'ans~erase (ALT), aspartate aminotrausferase (AST), y-glutamyltranspeptidase (GGT) and insulin resistance levels calculated by homeosta- sis model assessment index (HOMA-R) were examined in 422 applicants (207 males, 215 females) attending for tontine health check-ups Those with hepatitis B or C, taking oral hypoglycemic agents and receiving insulin therapy were excluded. Average value of HO1~La.- R in those without cardiovascular risk tactors was calculated as 14 -+ 0,5 (mean _+ SD), therefore, upper limit of normal range of HOMA-R was defined as 1 9 In whole applicants, ALT, AST and GGT were positively correlated with HOMA-R significantly (r = 0.333, = 0,279 and r = 0.198, respectively, P < 0.0001), Average levels of HOMA-R were not statistically" ditterent between male and female applicants, however, in those with increased insulin resistance (above upper limit of HOMA-R), ALT and GTT were significantly higher in male than in fmnale (38 _+ 25 IU/L vs, 23 _+ 14 IU/L, P < 00001_ and 91 _+ 133 IU/ L vs. 33 _+ 33 [U/h, P = 0.0003, respectivdy) Hepatic enzyme elevation influenced by increased insulin resistance was revealed to be greater in male than in female probably reflecting the difference of alcohol intake between male and fetnale, In conclusion, insulin resistance m W play an important role in hepatic enzyme elevation in a general population In occasional or habitual dnnkers, insulin resistance and alcohol consumption seem to synergistically affect hepatic enzyme elevation. Therapy" to decrease insulin resistance as well as abstinence will be encouraged in such patients. M1405 Cost Effectiveness of Cytological Examination of Ascitic Fluid in Patients with Cirrhosis Andria M. Mushahwar, M.d., Joseph A. Awad, M,d. Context: Review of the literatm'e indicates that the recovery of malignant cells from ascitic fluid of cirrhotic patients is rare However, cytological examination ot ascitic fluid is done routinely at maW medical centers despite this data. Objective: To examine the utility of cytological examination of ascitic fluid as a screening diagnostic tool for malignancy in terms of cost eftectiveness Design: Retrospective cohort study of male veterans with abdominal ascites who underwent ascitic fluid cytological analysis between February 1996 and December 1998. Setting: Two VA hospitals in Middle Tennessee. Participants: Male veterans with ahdomiual ascites (primardy due to cirrhosis) with specimens (non-OR) submitted for cytologicai analysis. There were 239 specimens dunng the study period. Methods: Clinical and laboratory data from all the patients who had diagnostic paracentesis and cytological analysis of ascitic fluid in two VA hospitals in Temresee between 2/1996 and 12/1998 was collected including diagnosis, serum protein and albumin, AFP, peritoneal albumin and protein, and cytology"exam result. Results: < 1% of cytological specimens showed malignancy in our patient population. In all cases, malignancy was established by" other means prior to ascites analysis. No cases of hepatoma were diagnosed by examining ascites cytology. Discus- sion: The low diagnostic yield of ascites cytology' tests in our patient population raises the question of the cost eftectiveness of cytological analysis of ascitic fluid, especially when the desire is to assess for hepatoma. A technical fee of $108 is charged for cytological analysis at our institution and Medicare reimbursement for pathologists is $30 per case, thus >$30,000 of excess charges were generated over 3 years We propose to study an intervenuon using the electronic order entry" process at our academic medical center to see if physician behavior can be altered to bring ordering of ascites fluid cytology in line with e~dence- based guidelines. M1406 Impact of A Culturally Appropriate Hepatitis B Virus (HBV) Video on HBV Vaccine Acceptance by Homeless Caregivers Kathleen B, Schwarz, Beth Stover, C Ailene Staples, P, Yvonne Barnes, Jennifer Lee, Joseph Bareta, Yvette Bowser Although HBV is common among the homeless there is little data on either HBV vaccine coverage rotes or the success of HBV vaccine programs m this high risk population. Although m theory, special culturally appropriate educational tools should increase HBV vaccine coverage rates, there are many destabilizing factors working against such logical approaches Therefore we performed a randomized controlled trial to assess the impact oI an 8 mm culturally appropriate video on the adverse health consequences of HBV (Respect Yoursdf; Protect Yourself by Hepatitis Foundation International) or smoking (Bilal's Dream by lqr Productions, inc.) followed by a PowerPoint presentation providing addinonal information We assessed the impact of this education on 1)Knowledge of HBV 2)Acceptance rates fcr HBV vaccine #1 and 3)Return rates for HBV vaccine #2. Results were as follows: HBV Education Smoking Education, ,, p value n 32 25 HBV knowledge visit #1 Care. 8 ~ 2 8 2 HBV knowindge Vidt #t 63 53 Tesn$ HBV tmov~edge visit #2 Care- 91 82 givers HBV knowledge visit #2 8-2 6 ~ 3 Teens Acce~ vaccine #1% Yes 100 92 01880 Return vaccine #2 % Yes 72 56 0,2127 Finish Study % 69 44 0,0604 Conclusions: A cu~rally ~riate video to educate homeless families about HBV is associal~ with an (insignificant) trend to increasevaccineacceptanceand compliance r~t~. $~d~ of a larger group and analysis of cost benefit (including tracking time) witl be necessary to fullyacce~ the impact. AASLD Abstracts A-748