Doença hepática gordurosa não alcoólica: caractéristicas clínicas e histológicas em obesos graves submetidos à cirurgia bariátrica

UNLABELLED: Obesity is an important risk factor of Nonalcoholic Fatty Liver Disease (NAFLD) and it has been considered a predictor of severity of this condition. However, in severe obese patients the spectrum of NAFLD is in discussion. AIM: To describe the clinical and histological characteristics of NAFLD in obese patients submitted to bariatric surgery. METHODOLOGY: The study included 141 severe obese (BMI > or = 35kg/m2) who underwent bariatric surgery from October 2004 to May 2005 had clinical and histological diagnosis of NAFLD. Exclusion criteria: alcoholic intake more than 140 g/week, positive markers for other liver diseases. All patients were submitted to hepatic biopsy, as first procedure during the surgery. RESULTS: The mean age of the patients was of 37.3 +/- 11.1 years and 76.4% were female. BMI was greater than 40 kg/m2 in 77.7% of the cases. The frequency of metabolic syndrome was 51.9% (104). Elevated aminotransferases and hepatic steatosis on ultrasound were present in 29.5% (105) and 59.0% (105) respectively. Normal liver biopsy or unspecfic findings were found in 11.3% of the cases and NAFLD in 88.7%: isolated steatosis in 2.8%, steatohepatitis (NASH) in 85.1% (NASH and fibrosis in 76.6%) and cirrhosis in 0.7%. CONCLUSIONS: NAFLD in severe obese patients, in general, was asymptomatic and presented normal enzymes, liver function and ultrasound. However, it has a large histological spectrum and cases of steatohepatitis with fibrosis were more frequent. These results suggest that liver biopsy may be considered during the bariatric surgery to better diagnosis and prognosis of severe obese patients.