Most patients with severe obesity has liver fibrosis even without Metabolic Syndrome/ A maioria dos pacientes com obesidade grave apresenta fibrose Hepática mesmo sem Síndrome Metabólica
DOI:
https://doi.org/10.34119/bjhrv5n2-128Keywords:
1 non-alcoholic fatty liver disease, 2 morbid obesity, 3 metabolic syndrome, 4 nonalcoholic steatohepatitis, 5 steatosis.Abstract
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a condition commonly associated with metabolic syndrome (MS). This association is frequently found in people with severe obesity, yet some who are diagnosed with NAFLD do not fulfill the criteria for MS. We aimed to compare the clinical and histological characteristics of NAFLD in patients with obesity with and without MS.METHODOLOGY: Cross-sectional study with patients with severe obesity (BMI ≥35kg/m2) diagnosed with NAFLD on liver biopsy during bariatric surgery between Sep/2014 and May/2015. Patients with a history of chronic alcohol consumption and other liver diseases were excluded. MS diagnosis was based on the International Diabetes Federation criteria. Statistical analyses were performed using Chi-square and t tests. P<0.05 were considered significant. RESULTS: The simple included 170 patients with severe obesity with histological diagnosis of NAFLD. The mean BMI (body mass index) was 43.2±5.3 kg/m2; 60% were female and the mean age was 37.1±10.7 years. Dyslipidemia (81.7%) and arterial hypertension (48.2%) were the most frequent NAFLD risk factor associated with obesity in these patients. A total of 75 of them (44.1%) did not meet the criteria for MS. They were younger than those with MS [33.8 (9.9) vs 39.7 (10.8) years; p<0.001], and 68.0% (51) of them had nonalcoholic steatohepatitis (NASH) and fibrosis. CONCLUSION: The results reinforce the relevance to evaluate NAFLD in people with severe obesity, even those without MS. Despite not presenting MS, these patients with severe obesity already had NASH with fibrosis and can potentially evolve to cirrhosis.
References
Organization WH. Obesity: preventing and managing the global epidemic: World Health Organization; 2000
Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não transmissíveis e Promoção da Saúde. VIGITEL Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília, DF: Ministério da Saúde; 2019. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2019_vigilancia_fatores_risco.pdf
Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94(9):2467-74. https://doi.org/10.1111/j.1572-0241.1999.01377.x
Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413-9. https://doi.org/10.1016/S0016-5085(99)70506-8
Daltro, C.; Cotrim, HP; Alves, E. S.; Freitas, L. A. R.; Araujo, L. M. B.; Boente, L. A.; Leal, R. A.; Portugal, T. Nonalcoholic Fatty Liver Disease Associated with Obstructive Sleep Apnea: Just A Coincidence? Obesity Surgery, V. 20, P. 1536- 1543, 2010. https://doi.org/10.1007/s11695-010-0212-1
Cotrim, HP; Daltro, C. Liver: Does Bariatric Surgery Reduce the Severity of NAFLD? Nat Rev Gastro Hepato, V. 7, P. 11-13, 2010. https://doi.org/10.1038/nrgastro.2009.215
Daltro, C.; Gregorio, P. B.; Alves, E. S.; Abreu, M. C.; Bomfim, D. V. V.; Chicourel, M. H.; Araujo, L. M. B.; Cotrim, HP. Prevalence and Severity of Sleep Apnea in a Group of patients with morbidly obesity. Obesity Surgery, V. 17, P. 21- 25, 2007. https://doi.org/10.1007/s11695-007-9147-6
Barros, RK; Cotrim HP; Daltro, C.; Alves, ES. Daltro, Cs; Oliveira, Y. Nonalcoholic steatohepatitis in severely obese subjects: coffee consumption vs. disease severity. Ann of Hepatol, v. 15, p. 350-353, 2016. https://doi.org/10.5604/16652681.1198804
Holt RI. International Diabetes Federation re-defines the metabolic syndrome. Diabetes Obes Metab. 2005;7(5):618-20. https://doi.org/10.1111/j.1463-1326.2005.00519.x
Guidorizzi de Siqueira AC, Cotrim HP, Rocha R, Carvalho FM, de Freitas LA, Barreto D et al. Non-alcoholic fatty liver disease and insulin resistance: importance of risk factors and histological spectrum. Eur J Gastroenterol Hepatol. 2005 Aug;17(8):837-41. https://doi.org/10.1097/00042737-200508000-00010
Chang Y, Jung HS, Cho J, Zhang Y, Yun KE, Lazo M, et al. Metabolically Healthy Obesity and the Development of Nonalcoholic Fatty Liver Disease. Am J Gastroenterol. 2016;111(8):1133-40. https://doi.org/10.1038/ajg.2016.178
Ampuero J, Aller R, Gallego-Durán R, Banales JM, Crespo J, García-Monzón C, et al. The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity. Aliment Pharmacol Ther. 2018;48(11- 12):1260-70. https://doi.org/10.1111/apt.15015
Kim Y, Chang Y, Cho YK, Ahn J, Shin H, Ryu S. Metabolically healthy versus unhealthy obesity and risk of fibrosis progression in non-alcoholic fatty liver disease. Liver Int. 2019;39(10):1884-94. https://doi.org/10.1111/liv.14184
Lonardo A, Mantovani A, Lugari S, Targher G. Epidemiology and Physiopathology Of The Association Between Nafld And Metabolically Healthy or Metabolically Unhealthy Obesity. Annals of Hepatology. 2020. https://doi.org/10.1016/j.aohep.2020.03.001 (in press).
Beh S. Is metabolically healthy obesity a useful concept? Diabet Med. 2019;36(5):539-45. https://doi.org/10.1111/dme.13869
Goday A, Calvo E, Vázquez LA, Caveda E, Margallo T, Catalina-Romero C, et al. Prevalence and clinical characteristics of metabolically healthy obese individuals and other obese/non-obese metabolic phenotypes in a working population: results from the Icaria study. BMC Public Health. 2016;16:248. https://doi.org/10.1186/s12889-016-2921-4
Soriguer F, Gutiérrez-Repiso C, Rubio-Martín E, García-Fuentes E, Almaraz MC, Colomo N, et al. Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study. J Clin Endocrinol Metab. 2013;98(6):2318-25. https://doi.org/10.1210/jc.2012-4253
Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol. 2010;53(2):372-84. https://doi.org/10.1016/j.jhep.2010.04.008
Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10(6):330- 44. https://doi.org/10.1038/nrgastro.2013.41
Leite NC, Villela-Nogueira CA, Cardoso CR, Salles GF. Non-alcoholic fatty liver disease and diabetes: from physiopathological interplay to diagnosis and treatment. World J Gastroenterol. 2014;20(26):8377-92. https://doi.org/10.3748/wjg.v20.i26.8377
Duarte SMB, Stefano JT, Oliveira CP. Microbiota and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH). Ann Hepatol. 2019;18(3):416-21. https://doi.org/10.1016/j.aohep.2019.04.006.
Santos, MST; Santos ACOL; Noronha VFC; Jesus JB; Cruz MAF; Lima SOL; Cruz JF. The influence of obesity in the non-alcoholic fatty liver disease. Brazilian Journal of Health Review, V.4, n.2, p. 5021-5033, mar./apr.2021.
