Chapter 7 

 DIETARY LIVER NECROSIS 



A he last twenty-five years has seen the emergence of a new 

 chapter in the history of nutritional defects that offers important 

 lessons for cellular pathology. Two distinct types of disturbance of 

 the liver have now been traced to dietary deficiency; it is one of 

 these we wish to discuss in this section. The other type, in which 

 the liver becomes fatty and in time cirrhotic, is caused by a lack 

 of choline, betaine or methyl precursors, vitamin B i2 or folic acid. 

 We have already dealt with this topic in the chapter on fats. The 

 condition that we are about to discuss is called "dietary liver 

 necrosis" or "acute massive necrosis of the liver." 



THE DISCOVERY OF DIETARY LIVER NECROSIS 



In 1935, Weichselbaum, working at Edinburgh, noticed that 

 rats fed diets low in protein and deficient in 1 -cystine (and quite 

 likely methionine) became ill and died after approximately six 

 weeks. The liver of such animals was swollen and haemorrhagic, 

 and presumably necrotic, but Weichselbaum gave no histological 

 description from which to decide this point. Definite liver changes 

 were noted by Gyorgy and Goldblatt (1939) who fed rats on low 

 casein diets deficient both in lipotropic factors and in thio-amino 

 acids. They showed that casein and methionine could protect rats. 

 Meanwhile, Himsworth and Glynn (1945) had formed very similar 

 opinions and gave the first detailed account of massive dietary 

 necrosis in the liver. They also showed that bacterial or viral infec- 

 tion played no vital part in the process. Similar results were ob- 

 tained by Daft, Sebrell and Lillie (1942) , who found that the 

 liver damage could be prevented by adequate supplies of methio- 

 nine and cystine. Since choline had no influence on the necrosis it 

 seemed likely that this was a distinct entity from fatty liver 

 and cirrhosis. German investigators likewise had encountered these 

 effects of cystine deficiency (Hoch and Fink, 1943) . As a result of 



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