Comparison of the severity of non-alcoholic fatty liver disease in diabetic and non-diabetic obese patients.

Paulo Roberto Ott-Fontes,João Alfredo Diedrich Neto,Marcos Bertozzi Goldoni

doi:10.1590/0100-6991e-20202485

Paulo Roberto Ott-Fontes, João Alfredo Diedrich Neto + Show 1 more

Open Access

https://doi.org/10.1590/0100-6991e-20202485

Copy DOI

Abstract

nonalcoholic fatty liver disease presents a broad spectrum of histopathological alterations, from steatosis to liver cirrhosis. Patients with diabetes mellitus (DM) present increased incidence and severity of NAFLD. determine the prevalence and severity of NAFLD in diabetic and non-diabetic obese patients undergoing bariatric surgery. the evaluation of liver biopsies was carried out through NAFLD activity score (NAS) in order to evaluate degree of hepatic steatosis, presence of ballooning, inflammatory activity and degree of fibrosis. a total of 154 patients who have undergone bariatric surgery with intraoperative biopsy were observed and divided into two BMI ranges: from 35 to 44.9 and from 45 to 54.9. 32 (20.8%) from 154 patients were diabetic and 122 (79.2%) were non-diabetic. Patients with DM were significantly older than patients without the disease, presenting 41.29 ± 9.40 years vs 36.71 ± 10.13 years in the group with BMI of 35 to 44.9 (p=0.049); and 45.13 ± 7.10 years vs 37.00 ± 9.24 years in the group with BMI of 45 to 54.9 (p=0.024). In the histological evaluation, patients with DM from the BMI group of 35 to 44.9 had a strong association with higher prevalence and severity of steatosis, balloning, inflammation, fibrosis and steatohepatitis. the present study confirms the high prevalence of NAFLD in patients with Morbid Obesity. Prevalence and severity increase proportionally to BMI and who have DM as comorbidity.

Highlights

Non-alcoholic fatty liver disease (NAFLD) is the accumulation of triglycerides in hepatocytes, which can lead to an increase in liver mass by 5-10%1 in individuals with low alcohol consumption
Patients with T2DM were significantly older than patients without the condition, 41.29 ± 9.40 years vs 36.71 ± 10.13 years, in the group with a body mass index (BMI) of 35 44.9 kg/m2 (p = 0.049) and 45.13 ± 7.10 years vs 37.00 ± 9.24 years in the group with a BMI of 45 54.9 kg/m2 (p = 0.024). In this latter group there was a significant association of diabetes with the presence of systemic arterial hypertension (SAH) (p = 0.033), according to the data expressed in table 1
We should mention that of these patients, 109 underwent gastric bypass, a classic technique for the treatment of obesity

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) is the accumulation of triglycerides in hepatocytes, which can lead to an increase in liver mass by 5-10%1 in individuals with low alcohol consumption. It presents different degrees of histological alterations, divided into simple hepatic steatosis (HS) and nonalcoholic steatohepatitis (NASH), with the presence of inflammatory reaction, hepatocellular damage, ballooning of hepatocytes, with or without varying degrees of fibrosis[2], progressing to cirrhosis and hepatocellular carcinoma. NAFLD is considered the hepatic component of MS, being an independent risk factor for the development of cardiovascular disease[5]. Cardiovascular disease, not liver disease, is the most common cause of death among patients with this condition

Objectives

Results

Conclusion